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# of Engines: |
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Make/
Horsepower: |
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Purchase
price of boat ($)
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Purchase
price of trailer ($) |
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Limit of
Liability: |
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Mooring Location: |
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State:
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Navigation
Area: |
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Lay-up Period: |
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Years of
boating
Experience: |
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Boats previously owned:
(Please include years of ownership) |
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List navigation or
communication
equipment: |
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Prior
boating
claims: |
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Prior
Insurance
company: |
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Driving record
in an automobile:
(past 3 years) |
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Operator's
Date of Birth: |
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Have you
ever taken a
Coast Guard or
Power Squadron
Course?
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If "Yes",
which one(s)?: |
Coast Guard |
Power Squadron |
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