CALIFORNIA LICENSE # 0F89805
 
 
   
 
SPECIALTY INSURANCE
 
BOAT & YACHT INSURANCE QUOTE FORM
 
Business Name:
Full Name:
Address:
City:
State
ZIP:
Phone:
Home Phone Day Time Phone
   
E-Mail Address:
Who is this Quote for?
   
  Quote Info.
   
Occupation:
Date of Birth:
Years of Boating Experience:
Years Boat Owned:
Boating Courses / Licenses:
Any claims in last 5 years:
   
  Prior Boats Owned - Type, Size, Years Owned
   
Most Recent:
Previous:
Previous:
Previous:
   
  Vessel Info.
   
Purchase Price:
Date of survey if available:
Hull Power:
Add. Hull Info.
Make Year Model Horse Power
       
       
Year Purchased Length Construction  
       
 
   
  Engine Info.
   
Engine Info.
Make Year Model Horse Power
       
       
Engine Type Engine Fuel Engine Count  
       
 
   
  Boat Equipment Info.
   
Boat Equipment Info.

EPIRB

Depth Finder

Fume Detector

VHF

Radar

Automatic Halon / CO2

GPS

Loran

Navigation Software

   
  Vessel Use Info.
   
Type of Use:
Pleasure Charter Racing Commercial
Navigation Area:  
Mooring Location:  
If laid up part of the year,
from when to when:
From To Where
     
Paid Crew?
Yes No
   
  Required Coverage Info.
   
Hull and Machinery Limit:
Deductible:
P&I Liability Limit:
Current Insurance Company:
Expiration Date:
Current Premium:
   
     
 
 
 
 
 
 
 
 
 
 
 
Visit LIQUORSTOREGASSTATIONINSURANCE.COM for insurance services for Liquor Stores, Gas Stations, Workers Compensation & Liquor Liability Insurance.
 
LIQUORSTOREGASSTATIONINSURANCE.COM is wholly owned by Khalsa Insurance Agency, Inc.
 
GET INSURED TODAY, CALL US AT: 408.272.2500
 
CALIFORNIA LICENSE # 0F89805
 
SAN JOSE OFFICE
 
Khalsa Insurance Agency, 3750, Mckee Road Suite, A, San Jose, CA, 95127, United States of America.
 
T # 408.272.2500     |     F # 408.493.4552     |     Email:  info@khalsainsurance.com     |     View Directions
 

 
FRESNO OFFICE
 
Khalsa Insurance Agency, 2125 N Barton Av., Fresno, CA 93703, United States of America.
 
T # 408.272.2500     |     F # 408.493.4552     |     Email:  info@khalsainsurance.com
 
 

 
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