Boat Form
(800) 660-0204 (800) 660-0204

HWB

Specialists in mobile home insurance since 1973.

Many companies  to choose from.

Replacement Cost

Guaranteed Replacement

Actual Cash Value (ACV)

Flood

Earthquake

Life

Motorhome

Home

To give you the lowest possible rate, it's important that we have your age, your boating information, and the boat information.

Information provided will be used exclusively for your insurance quote. It will not be given or sold to others or used for any other marketing purposes. We'll give you a quote and we'll leave you alone! 

PERSONAL INFORMATION:

Name:

Address:

Phone:  Date of birth

Email:

Contact me by... Phone    Email    Mail    Fax to:

Have you had any boating claims in the last 5 years? No    Yes (explain)

Have you had any traffic violations in the last 3 years? No    Yes (explain)

Have you had any traffic accidents in the last 3 years? No    Yes (explain)

BOAT INFORMATION:

Year 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002     Make Length    Power Outboard Inboard Inboard/Outdrive Jet

HP    Speed     Where do you operate the boat?

Where kept? Same as above    Other     

Kept area locked Yes No N/A

LENDER

    Lender              

    Loan Number          Balance    

    Address