Hugh Cotton Insurance, Inc. - Online Boat Insurance Application

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Owner Information:
Name
Address
City
State
Zip
Date of Birth
Occupation
No. of Prior Boats Owned
Size Range
Years Boating Experience
Boating Courses (C/G or P/S)
Refused/Cancelled Insurance
Phone Number
Fax Number
Email Address
Present Carrier
Expires
Yacht Information:
Year
Length
Manufacturer
Model
Construction
Purchase Date
Total Purchase Price
Insured Value
Survey Available		Yes No In-water Out-of-water
Engine Information:
Year
Horsepower
Twin		Yes No
Manufacturer
Power		OB IB I/O Seadrive
Fuel Type		Gas Diesel
Speed
Value
Trailer Information:
Year
Manufacturer
Value
Tender Information:
Year
Length
Manufacturer
Horsepower
Engine Mfg.
Value
Miscellaneous Information
Navigation Equipment		VHF Depth Finder Loran Auto Fire Extinguisher Radar GPS
P & I Limit
Use
Navigation Limits
Storage Location or Name of Marina (Include city & state)
Additional Operators (Include Name, DOB, Occupation, Yrs. Exp, MVR Info)
Boat Claims within last 3 years (Include type, date and amount paid)