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Boatowners Insurance

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Personal Information
Name:*
City:*
State:*
Zip Code:*
Phone Number:*
Best Time To Call:*
Email Address:
Boat's Information
Hull Material (no wood):
Value of Boat, Motor, and Electronics (excluding the trailer):	$
Purchase price (including trailer):
Maximum Speed:	MPH
Purchase price:
The Boat's...
Manufacturer:
Model:
Year:
Make of Trailer:
Year of Trailer:
Value of trailer:	$
Mooring of Boat
City:
State:
Zip Code:
Residence or Name of Marina:
The Engines...
Number of Engines:
Make of Engine:
Type of Engines(I/O, OB, IB):
Type of fuel:
Fuel Capacity:
Horse Power (Per Engine):	HP
Additional Equipment on Boat
Owners and Operators
Owner or Operator #1
Name:
Age:
Occupation:
Marital Status:
Years of Boating Experience:
Drivers License Number:
Number of years as a Boat Owner:
Boating Courses Completed:
Losses or claims in the last five years (If Yes, explain):
Number and Year of any DUI (No Convicted Felons):
Speeding/Traffic Violations in the last three years (Explain):
Water Skiing Use:
Owner or Operator #2
Name:
Age:
Occupation:
Marital Status:
Years of Boating Experience:
Drivers License Number:
Number of years as a Boat Owner:
Boating Courses Completed:
Losses or claims in the last five years (If Yes, explain):
Number and Year of any DUI (No Convicted Felons):
Speeding/Traffic Violations in the last three years (Explain):
Water Skiing Use:
Owner or Operator #3
Name:
Age:
Occupation:
Marital Status:
Years of Boating Experience:
Drivers License Number:
Number of years as a Boat Owner:
Boating Courses Completed:
Losses or claims in the last five years (If Yes, explain):
Number and Year of any DUI (No Convicted Felons):
Speeding/Traffic Violations in the last three years (Explain):
Water Skiing Use:
Owner or Operator #4
Name:
Age:
Occupation:
Marital Status:
Years of Boating Experience:
Drivers License Number:
Number of years as a Boat Owner:
Boating Courses Completed:
Losses or claims in the last five years (If Yes, explain):
Number and Year of any DUI (No Convicted Felons):
Speeding/Traffic Violations in the last three years (Explain):
Water Skiing Use:
Additional Information
Hull ID #:
Motor Serial Number(s):
Lien Holders Name:
Lien Holders Address:
City:
State:
Zip Code:

* = Required Field

Cathell Insurance | info@cathellinsurance.com

Ocean City
12449 Ocean Gateway
Ocean City, Maryland 21842
Tel: 410-213-2241
Toll Free: 1-800-943-5373
Fax: 410-213-1267