Server: Microsoft-IIS/3.0 Date: Mon, 29 Dec 1997 18:15:44 GMT Content-Type: text/html Accept-Ranges: bytes Last-Modified: Thu, 21 Aug 1997 21:28:00 GMT Content-Length: 4838 Marine Insurance

Travis Boating Centers

Marine Insurance Quote Worksheet

Name:   
E-mail:  Phone:
City:    ST:  Zip:
County:    Date of Birth:
Total Years Boating Experience  
Any boat losses or more than 2 auto violations
in the last 5 years?
  If yes, please explain
  
  

Boat Information

Waters boat will be used in: Year: Make: Model: Length: ft inches Engine Type: Number of Engines: Horsepower: Hull Material

Dollar values (not including taxes)

Hull Outboard Engine Trailer Total with accessories Credits New Boat: Safety Course

Coverages (the defaults are standard)

Deductible: Liability Limit: Personal Effects: Medical Payments / Uninsured Boater: Premium Payment Options: