Personal Information
Name Insured:
*
Mailing Address:
*
City:
*
State:
*
Zip:
*
Phone:
*
Fax:
Email:
*
Website:
Contact Person:
*
Business Type:
Choose below...
Corporation
Partnership
Individual
Other
How did you hear about Voyager:
Type of Operation:
Physical Address:
How Long in Business:
# of Employees:
Current or Prior Insurance Carrier:
Policy #:
Expiration Date:
Effective Date:
Prior Losses/Claims:
Gross Receipts:
Annual Payroll by Classification:
Do you carry Workers Comp Insurance:
Workers Comp Expiration Date:
Building Construction:
Security/Alarms:
Sq. Footage:
Year Built:
Tenant/Bldg. Owner:
Building - Limit Requested:
Deductible for Building:
Contents - Limit Requested:
Deductible for Contents:
Floating Property/Docks - Limit Requested:
Deductible for Floating Property/Docks:
Loss of Income Floating Limit Requested:
Dock Construction:
Dock Year Built:
Inventory Limit:
In Transit Per Shipment Limit:
Inventory at Other Locations Limit:
Owned Vessels/Rental Boats:
Commercial General Liability Limit:
Marina Op Legal Liability Limit Requested: (non-owned vessels in your care, custody & control)
Protection & Indemnity Limit Requested: (liability coverage on the water)
Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough fields above, such as additional drivers, vehicles, driver histories, etc..., please enter them below.