Blackadar Marine Insurance Request For Insurance Quote

Boats & Yachts

Passenger Vessels | Commercial Marine | Professional Liability

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Use this form to submit a request for a no obligation price quote for your specific type of Marine Insurance.

To assure the timely and proper handling of your request, please indicate the type of vessel or insurance that would apply.

PLEASE CHECK WHICH TYPE APPLIES
	Boats/Yachts - Minimum Value $25,000.00 Please
	Passenger Vessels
	Commercial Marine
	Other

NOTE: All the following fields are required to provide an accurate quote. Only the ones marked with an * will return an error if incorrect or left blank.

Contact Information

First Name *			Last Name *

Date of Birth *

Social Security Number

E-mail *

Address *

City * State * Zip-Code *

Day Phone *	Home Phone *	Fax No.		Cell Phone

As part of the underwriting process, some companies will utilize an insurance score based upon your credit history. That insurance score may be used to underwrite and price your policy. You have the right to be told the name and address of the reporting agencies that provide these reports. You also have the right to review and correct your personal information. This information may be disclosed as per our privacy policies to properly service your policy or to conduct business.

Would you like us to obtain quotes from all of our companies including the ones that use credit history?

If you do not want us to utilize these companies, it may limit our options for quotations.


	Vessel Information

Boat Mfg.		Model

Year Built	Length	No. of Engines			Horsepower Ea.


Boat Value			Trailer Value	Home Port

Engine Manufacturer

Top Speed (MPH) *
On Board Electronics
Auto Fire System Depth Finder UHF LORAN GPS
Liability Limit Requested *
Navigational Area
Lay Up Period: From (Month / Day) To (Month / Day)
Where and How is the Vessel Stored
List any Boating Courses Taken
Number of Years of Boat Ownership
Make and Footage of Boats Owned Prior
Have any Claims Been Filed in the Last Five Years? Yes No

If "Yes" was Answered to Prior Question Regarding Claims Please Explain
My Insurance Expires in:
This Vessel is for:


	Please enter any comments, questions and/or additional descriptions.

Should we require additional information to complete your request, which form of communication would be most convenient?






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