Watercraft Insurance Form - Henry Insurance Service

Date

Name

First Last

DOB

SSN

Driver's License #

Occupation

How long?

Spouse's Name

First Last

DOB

SSN

Driver's License #

Occupation

How Long?

Contact #s

Email

Address

Street Address Address Line 2 City State ZIP Code

Where is the boat garaged? (home, marina, storage facility, etc?)

Years of experience operating a watercraft?

Have you taken a water safety course?

Is the watercraft rented or leased to others?

Previously salvaged?

Corporate owned?

Permanent living quarters?

Homemade or kit?

More than 2 motors?

Exposed engine, other than outboard?

Additional Operators

Name

First Last

DOB

SSN

Driver's License #

Address

Name

First Last

DOB

SSN

Driver's License #

Address

Watercraft Details

Hull value

Year

Make / Model

Length

Hull ID

Material

Usage

Radius or Operation

Motor Value

Year

Make / Model

Horsepower

Serial #

Max Speed

Inboard or Outboard

Inboard
Outboard

Trailer Value

Year

Make / Model

# Axels

Serial #

Coverages

Include limit & deductible

Type

Liability

UM

Medical

Hull / Trailer Damage

Fishing Equipment

Unattached Equipment

Towing

List all vehicles and watercraft tickets and accidents. Comments.

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Watercraft Insurance Quote

Additional Operators

Watercraft Details

Coverages