Boat & Personal Watercraft Quote
Date		Proposed Effective Date
Name		Ph#s
Source		Address
City		State
Zip		How long at Present?
Own Home?	Yes No	How Referred?
Prior Address		Prior Ins
Cancel Date		Other Ins w/ Certified
Driver #1
Name		DOB
LIC ST & #		SS#
Occupation		Relation
Viol & Acc & Claims
Driver #2
Name		DOB
LIC ST & #		SS#
Occupation		Relation
Viol & Acc & Claims
Driver #3
Name		DOB
LIC ST & #		SS#
Occupation		Relation
Viol & Acc & Claims
Boat or Personal Watercraft
Vessel Type		Feet
Year		Manufacturer
Serial #		Ownership
Hull Material		Year of Engine
Engine Type (Board)	In Out	Horse Power
Fuel Type		Top Speed
Value New		Safety Equip
Trailer? Value		Comp
Collision		Ext Coverage
Add Equipment		Use
Liability Coice