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If you would ike a quote on boat insurance from an agent who specializes in marine insurance from highly rated underwriters, copy the form below into a e-mail message, fill it out and then send it to me susan@imis.pro. Or if you would like to download the form as an attachment, click here and then e-mail or fax it.

Thanks,

Susan

International Marine Insurance Services
fax 443-926-0580
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==INTERNATIONAL MARINE INSURANCE SERVICES==
===VESSEL INSURANCE QUOTE REQUEST FORM====

OWNERSHIP:
 Owner(s)-
 Street address-
 City / State / ZIP-
 Home phone-                                
 Work phone-
 E-Mail address-
 Lienholder? -

OPERATOR(S):
 Name-
 Date of Birth-        
 Occupation-
 Years of boating experience-               
 Size(s) & Type(s) of Boat(s) operated-
 Years of boat ownership (any boat)-        
 Size(s) & Type(s) of Boat(s) owned (list length brand & for how long)-
 Boating courses completed-
 License held (if any)-
 Current insurance company-                 
 Expiration date-
 Describe boating accidents or losses, last 5 years - (date, cause, amount)

 (repeat details for any other regular operator)-

BOAT:
 Name-
 Model year-     
 Builder-             
 Model (or rig)-         
 Length overall-  
 Construction-                             
 Flag-
 Purchase Date-                            
 Purchase Cost-
 Total Investment - (improvements, not maintenance)

ENGINE(S):
 Number-        
 Year(s)-            
 Manufacturer(s)-                      
 Total Horsepower-    
 Fuel-

EQUIPMENT:
Automatic extinguisher [ ]    Fume detector [ ]     Theft Alarm [ ]
VHF radio [ ]    Depth finder [ ]    Loran or GPS [ ]   
Radar [ ]   EPIRB [ ]  Sextant [ ]   Paper Charts [ ]   
Weather Fax [ ]   Storm Sails [ ]

Describe Ground Tackle-

Other safety gear-

TENDER:
Model year-      
Builder-                         
Model or length-
Engine year-     
Manufacturer-                    
Horsepower-

USE (select all that apply):
Private pleasure [ ]    Liveaboard [ ]
Captain charter [ ]    Bareboat charter [ ]     
Racing [ ]   Number of paid crew [ ]

Navigation area-
Regular Mooring Location- (marina name & address)
Lay-up Period-
Afloat or Ashore?

COVERAGE:
Hull & equipment value-                  
Deductible-
Liability limit-
Tender value & motor value-
Other specifications-

How did you learn about International Marine Insurance Services?-


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