ALOHA INSURANCE SERVICES

Please enter the requested information below and it will be forwarded to the Marine insurance specialists at Aloha Insurance Services. We will contact you to discuss your options.

Owner Name:
Contact Name:
eMail Address (Required):
Address:

City:

State:

Zip Code:

Phone:

Fax:

Current Insurer (if applicable):

Expiration Date:

Years of Boating Experience:

BOAT INFORMATION
Vessel:	Year Built:		Length:
Engine Type:	None Inboard/Outboard Outboard Inboard	Fuel:	None Gasoline Diesel

Original Cost: $

Market Value: $

USE OF BOAT

This boat is primarily used for: Pleasure craft for personal use Commercial craft for business use   6 Pack Charters 12 Pack Charters Commercial Fishing Tours / Sightseeing Dive Tours Snorkel Tours Other:

Crew:	Paid Crew - How Many?
Date, Type & Amount of any Prior Losses: