Woodbury & Co. - Personal Watercraft Questionnaire

Watercraft Questionnaire
The following fields must be filled out completely and accurately in order to obtain a quote.

Personal Information
Owner:
Insured's Name:
E-mail
Address:
Prior Carrier:
Reason for Leaving:

Driver List
	Name		Dob	Yrs. Boat Exp	Auto Accidents/Violations w/ in past 36 months




Boat Information
	Boat Type			Deductible
	Year	Make	Model	Hull Material	Length	Present Value


Engine/Motor
	Year	Manufacturer		Horsepower	In/Outboard	Present Value



Equipment
	Item description					Value






Trailer
	Year	Make		Model		Present Value



Prior Losses (past 36 months):

Comments:



Items needed to bind coverage:
Hull ID
Engine ID
Complete Name
Address
Phone #
Maximum Speed of Boat:			mph
Number of miles taken offshore?			miles
Where is the boat moored?
Inland or Coastal Use?			Inland Coastal
Do you use your boat for water-skiing?			Yes No