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   Providing businesses and individuals

                    peace of mind

 






 

155 N. Ft. Thomas Ave.

Ft. Thomas, KY  41075

859-441-4100 phone

859-572-3056 fax

www.penderyins.com

 


Watercraft Insurance Questionnaire
 

Please complete the following questionnaire and click 'Submit.' A representative will contact you shortly.

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Name         

Phone        

Cell              

Address     

                      

Previous Address (if less than 3 years)

                    

                  

Occupation

Email          

Current Insurance Carrier

                 

How Long? Exp Date

 

Drivers in your Household

Name

Marital Status

Date of Birth

DL#

SSN#

ACC, VIOL, CLAIMS, 3 YRS

 

Vehicles in your Household

Driver

Year

Make/Model

VIN#

Annual Miles

Lease/Loan

Miles to Work/Schoo

Full or Liability

 

Boat Details 

 

Year of Boat Make/Model  

Type            

Hull Material  Length Current Value

Year of Motor Make/Model  

Inboard/Outboard/IO

Horsepower Speed Current Value

Year of Trailer Make/Model Current Value

Liability Physical Damage Deductible

Boater's Safety Course?

 

To provide a quote, our insurance companies use information such as driving records, claims and credit history from consumer reporting agencies.

 

 

 

 

GOOD STUDENT____ AWAY AT SCHOOL ______  WITH VEHICLE OR WITHOUT

 

 

To provide a quote, our Insurance companies use information such as driving records, claims and credit history from consumer reporting agencies.