Dennis Smith

Insurance Agency

   

 

 

       
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Dennis Smith

Insurance Agency

(602) 375-0880

 

 


 

 

Get a QUICK, FREE, PERSONALIZED AND ACCURATE QUOTE NOW!

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(602) FARMERS (602.327.6377)

or

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Personal Information will not be sold, leased, or otherwise distributed or

disclosed to outside parties unless required by law.

Name*

DOB

Address*

Occupation
City/St/Zip*
 
 
Hm Phone*
Wk Phone
Email*
FAX

Boats Owned*

 
 
Comments:
   

Detailed Information:

 
Boating/Sailing/Safety Classes
Other Experience
Previous Losses (3 Yrs)
Current Insurance Company
Name of Lender
Marina addt'l insured
   
Name Moorage Loc
Builder Year
Type Max Speed
Engine Manuf Engine Yr
Single/Twin    
Last Survey Dt Survey By
Market Value Repl Value
       

Auto Halon/CO2

VHF

SSB

 

Depth

GPS

Radar

 

WeatherFax

Other Nav

     
             
Tender:    Yr

Length

Make/Model

 
Outboard: Yr

H.P.

Make/Model

 

Navigation Limits

Paid Crew (if any)
Offshore Cruising/Racing Anticipated
                 
Deductibles

1%

2%

3% other
Hull Value  $
Liability  $
Pers. Effects $
Medical  $

Tender/

Outboard  $

Notes:

* denotes a required field

 

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