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
 Watercraft Policy Service Request
The following request does not guarantee coverage or a coverage change. This information will be acknowledged from our office with 2 business days following this request. Authorized staff from our office will confirm any changes and inform you of the effective date and time of your change.
All required fields must be answered in order for this request to be processed.

Name (REQUIRED)   
Last 4 digits of your policy number (REQUIRED)   
Day Phone (REQUIRED)   
Night Phone (REQUIRED)   
Best time to call (REQUIRED)   

E-Mail Address 

  

 Boat and/or Coverage Change
 
Please change Existing Boat #
 From: Year MakeModelLength

 To: Year MakeModelHULL #

 Motor: Year MakeModelSerial #Horsepower Type

Hull material

 

 Type of boat

  

  Use of new Boat

  
 
Hull Value  
Hull Deductible  
Liability Limit (000)  
 Medical Payments  
Would you like confirmation of a premium change that may be generated by this request?   

Add a new Operator
 Operator's full name  
 Birth date  
 Driver License number  
 Drivers Education Completed?  

 Lien holder Information

 Add
  
 New Lien holder to Boat #  
 Lien holder Name & Address  

 Delete
  
 Lien holder from boat #  
 Lien holder Name  

Please have someone call me with the following information about my boat policy?

  

 I would like information on the following additional coverages

Home Life Annuities Health Disability Income Long Term Care Commercial Vehicles Business CoverageIRA Auto
 
 
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mail to: gkh@InsuranceQuote.net
 
 
Page Created 6-6-01
 
 
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