Boat Application

     

 

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TOTALINSURANCEBROKERAGE, LLC

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Please complete all the items below  
Your Name
Your Mailing Address
Telephone Number
Your E-mail Address
Boat Manufacturer
Boat Model
Boat Year Constructed
Boat Serial Number
Boat Cost New
Use of boat including body
of water navigated
Zip code where boat is moored
or docked
Hull Material (fiberglass, wood, etc.)
Number of engines
Horsepower of each engine
Are engines?
Inboard?
Outboard?
Inboard/outboard?
Length of boat
Maximum Speed under full power
Trailer (year, make and ID number)
Years experience as a boater
Your boat operator's license number
Name of other operators other than
the applicant along with their
age and boat operator
license numbers.
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Total Insurance Brokerage, LLC
is a full-service Property and Casualty Insurance Brokerage
firm licensed in Connecticut, New York, New Jersey, and Florida
5 Hillandale Avenue
Stamford, CT 06902
Phone (203) 325-3613
Fax (203) 325-3204