Lake West Marine Insurance Quote Form

    SECTION 1 * OWNER/BENEFICIAL OWNER INFORMATION

  • SECTION 2 * VESSEL INFORMATION

  • SECTION 3 * OWNER EXPERIENCE & LOSS HISTORY

  • If multiple watercraft, list largest to smallest.
  • SECTION 4 * PRIMARY MOORING ADDRESS / NAVIGATION / VESSEL USE / STORAGE

  • SECTION 5 * SERIAL NUMBERS / LOSS PAYEE / TRAILER / ENGINE INFORMATION

  • Coverage Type & Limits

  • ADDITIONAL COMMENTS

 

Verification

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