Klump Insurance Agency, LTD.
"We do the shopping for you"
 
2864 Sugartree Lane
Maryland Heights, MO 63043
314-739-1346
314-739-1360 (fax)
E-mail:JeffKlump@SBCGLOBAL.NET

Our agency is licensed to quote and write insurance policies only in Missouri. To find agents offering these coverage in all of the other states, please click the IQ.net logo.

 

Boat Insurance Quote
Complete and submit this form to our agency

 
 Personal Information
  Name (required)  
 E-Mail Address (required)  
 Address  
 City/State/Zip(required)  
 Home Phone  
 Work Phone  
 Fax  
 Operators
 First Name Birthdate Has Operator completed Coast Guard Auxiliary or Power Squadron course?
#1    
#2
#3    
 Boat Information (ALL INFO REQUIRED)
 Boat Currently Insured?  
Policy Expires Month/Year
Current/Desired Policy Deductible  
 Boat Type
 Use
Where is vessel stored
 Waters Navigated  

 Used for Racing?

  
 Hull
 Make/Model  
  Hull Type  
 Length  
Estimated Market Value  
Year Built
 Max Speed (in MPH)  
   
 Personal Effects? (Amount)  
   
Misc Boating Equip? (Amount)  
   
 Engine(s)
 #1 Engine
 Make  Year
 Type
 Fuel Type
 Est. Value (O/B Only)
 Horse Power

#2 Engine

 Make  Year
 Type  
 Fuel Type  
 Est. Value (O/B Only)
 Horse Power
 Trailer?
 If Yes
 Make  
 Value  
 Liability Coverage
 Liability  
 Medical Payments  
 Water Ski Medical Needed  
 Explain all yes answers below
Has any listed operator been involved in a boating accident within the past 5 years?  
Has your boat and / or equipment suffered damage from any cause within the past 5 years ?  
Has any listed operator been involved in an auto accident or received a moving traffic citation in the past 3 years?  
  Remarks
 


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mail to: gkh@InsuranceQuote.net
 
 
 
Page Created 6-6-01
 
 
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