LS INSURANCE SERVICE | WaterCraft Insurance Form

Owner Information

First Name:

Last Name:

Address:

City

State:

Zip:

Home Phone

Work Phone

Cell Phone

Email Address

Boating Experience

Prior years of boating experience:

Sizes & types of boats owned:

Sizes & types of boats operated:

Prior boating claims and losses:

Boating safety courses completed:

Other Courses or Training:

Boat Information

Is this a new Purchace:

Purchase Date:

What type of Boat is this:

Year:

Make:

Model:

Hull Material:

Length (Ft.):

Engine Type:

Engine Configuration:

Fuel Type:

Total Horsepower:

Top Speed:

Type of Use:

Primary area for use:

Dinghy/outboard/kickermotor:

Value:

How is boat stored in Boating season:

Where is boat stored in Boating season:

How is boat stored in off season:

Where is boat stored in off season:

Trailer Information

Trailer Year:

Trailer Make:

Value and Coverage Information

Total cost of vessel and engines:

Liability Caverage:

Existing Insurance information:

Comments:

WaterCraft

Insurance Questionnaire

Owner Information

Boating Experience

Boat Information

Trailer Information

Value and Coverage Information