Davis Insurance Group - Boat/Watercraft Insurance Form

TODAY's DATE:*
DATE NEEDED:*
HOUSEBOAT & YACHT QUOTE SHEET
WHERE IS THE BOAT LOCATED?:
HOW DID YOU HEAR ABOUT US?:
NAME:*
ADDRESS:*
CITY:*
ST:*
ZIP:*
PHONE NUMBER:*
E-MAIL:*
OCCUPATION:
OPERATORS:
MANUFACTURER OF BOAT:
YEAR:
LENGHT:
DATE PURCHASED:
PURCHASE PRICE:
SURVEY:
ENGINE INFO
ENGINE YEAR:
ENGINE MFG:
TYPE:
TOTAL HP:
EXPERIENCE
YEARS BOATING:
YEARS AS BOAT OWNER:
PRIOR OWNED:
OPERATING EXPERIENCE:
LOSS HISTORY LAST 5 YRS:
MOORING:
LOCATION:
ADDRESS:
NAVIGATION AREA:
LAY-UP FROM:
LAY-UP TO:
AMOUNT OF INSURANCE
HULL & EQUIPMENT:
DEDUCTIBLE (1% MINIMUM):
LIABILITY LIMITS (STANDARD IS $500,000):
CURRENT CARRIER:
LIENHOLDER NAME AND ADDRESS:
HULL ID#:
ENGINE SERIAL #:
Davis Insurance Group / PO Box 935 Albany, KY 42602
Phone (606) 387-4297 Fax (606) 731-0400
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