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Pleasure Craft Insurance Quote Form
Please complete the following form to receive a quick quote.

Personal Information
         
First Name:
 
Last Name:
   
 
Date of Birth:
 
Current Occupation:
 

Additional Named Insured:
 
Date of Birth:
 
Current Occupation:
         
Address:
   
 
City/Town:
  
Province:
   
 
Postal Code:
 
 
   
 
Home Phone:
 
Work Phone:
   
 
Fax:
  
Email:
   
 
Have you ever had an automobile insurance policy cancelled or declined?
Yes No
   
 
Have you had any claims in the last 5 years?
Yes No
   
 
 
Vessel Type:    
           
Year:
Make:
Model:
     
Max Speed:
      
       
Current Survey:
 Yes No  
Date of Survey :
         
CYA/CPS :
 Yes No      
   
 
Value:

Hull & Machinery

 $
 
Trailer/Cradle
 $
 
Personal Effects/Equipment/Electronics
$
 
Tender
 $
 
Liability
$
         
Additional Notes:
     
         
Current Insurer:
 
Expiry Date:
         
         

1262 Bedford Highway Bedford, Nova Scotia Canada B4A 1C7
Tel: (902) 835-1262 Fax: (902) 835-2604 Toll free 1-877-925-2285