The Fitzpatrick Agency, Inc. - Boat Insurance Quotes

Please complete the following form to receive a free quote on boat/yacht insurance. We are licensed to sell boat/yacht insurance in ME, NH, MA, RI, CT, NY, NJ, DEL, MD, and VA.

Name*:

Gender	Name

Address*:

City*	State*	ZIP*

Home Phone*:

Business Phone:

E-mail*:

Make of boat*:

Model

Year built*

Length*

Approx. Date Purchased

Approx. Purchase Price

Current Boat Value

* required field


Equipment:

Radio	Radar
Depthfinder	Anti-theft device
Halon/Fire system	Vapor Detector
Loran	GPS

Engine:

Type:	Single	Twin

Fuel:	Gas	Diesel

Experience:

Years in Boating	Years as an Owner

Previous Boats Owned:

Please indicate desired coverage:

Deductible	1%	2%	Quote both?
Liability limits:	$300,000	$500,000

Current Insurance Company

Expiration of current policy

Please describe any claims in the last 3 years:

Please provide any further information:

The Fitzpatrick Agency, Inc.
840 Clinton Avenue, P.O. Box G, Bridgeport, CT 06605
Tel: (800) 727-5050 (203) 336-2138
Fax: (203) 336-9507
info@fitzpatrickagency.com
© 2001 The Fitzpatrick Agency, Inc.

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