Boat/Yacht Application

Owner and Title Information

Last name 1

First name 1

Birth Date 1

Last Name 2

First Name 2

Birth Date 2

Street Address

City

State

Zip Code

Phone Number

Email Address

Boat Information

Make/Model

Boat Length (Ft+In)

Year Built

Purchase Price

Date Purchased

Horsepower (per engine)

Number of Engines

Engine Make

Maximum Speed

Did you have a survey in the last 2 years?

Tender Description

Boating Experience

Years Boating Experience

Years Boating Ownership

Prior Boar Ownership:

Prior Ownership Make 1

Make of boat

Length 1

Length in feet

Years Owned 1

Prior Ownership Make 2

Make of boat

Length 2

Length in feet

Years Owned 2

Prior Ownership Make 3

Make of boat

Length 3

Length in feet

Years Owned 3

Mooring Information

Summer Address (7/1 - 11/1)

(Street Address, City, State/Local, Zip Code, Country)

Winter Address

(Street Address, City, State/Local, Zip Code, Country)

Layup Details

Provide dates and location details

Additional Information

Boating Classes/Certifications/Licenses

Navigation Area

Vessel Use

Do you liveaboard?

Operator 1 Driver License Number & State

Operator 2 Driver License Number & State

Are you married?

Are there Lithium Batteries?

Will you have a paid captain and/or crew?

List the insurance companies you are currently working with or recently insured by

List insurance companies separated by a comma

Claim History

Have you filed a claim?

Upload Survey and/or Captain License Here