Yacht Insurance Since 1936

 
 

   Request A Quote

 

Please complete the NO OBLIGATION quote form below.  Fields marked with an * are required.

ALL information on the following form is provided to our office through a secure site.

 

  Owner Information

 

Name:

*

Street:

*

City:

State:

Zip Code:

Phone Number:

(format 555-555-5555)

Fax:

(format 555-555-5555)

Email:

*

Preferred Contact Method:

Drivers License Number (optional):
Date of Birth: * (format MM/DD/YYYY)
   

Previous vessels owned:

 

Please include type (Power or Sail), Manufacturer, length & years owned)

   

Previous vessels operated:

 

Please include type (Power or Sail), Manufacturer, length & years operated)

 

 

  Vessel Information

 

 

Vessel Type:

Year Built:

*

Builder:

Model:

*

Length:

*

Hull Material:

*
If Other, please specify:

 

ENGINE MFG:

Engine Type:

# of Engines:

HP per Engine:

Fuel:

Summer Location of Vessel:
Zip Code

 

 

Winter Location of Vessel:
Zip Code
   
Loss History:
Date of Last Survey:

 

 

  Operator Information (List all principal operators including owner)

 

 

Name

Date of Birth

Years Exp.

% of Use

Boating Safety Course

Do you have a paid captain or crew?
   

  Coverage Requested

 

 

Hull & Equipment Limit:

*

Deductible Amount:

if Other, please specify:

Liability Limit:

Trailer Value:
Navigation Territory: if Other, please specify:
Lay-up Period:

if Other, please specify:

Hurricane Haul-Out Reimbursement:

 

 

  Vessel Credit Information

   

GPS

EPRIB

Radar

Gasoline Vapor Detector

Ship/Shore Radio

Automatic Fire Suppression System

Depth Sounder

 

 

 

 

  Additional Remarks (not required)

 

 

 

 

 

I am done,

 

 


W. & L. Howland Insurance Agency, Inc.
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