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Office Location: |
Telephone #: 603-382-9211 or 800-295-9211 FAX #: 603-382-3387 |
Emergency contact # 877-487-9339, leave your name & number with the operator
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Are you properly covered for your Sailboat,
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U.S. Coast Guard Navigation Course | |||||||||||
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U.S. Power Squadron Safety Courses | |||||||||||
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Navigational Equipment
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NO OBLIGATION COMPARISON QUOTE- Only complete this form if you are a resident of the state of New Hampshire.
After submitting the requested information, the Hills Insurance Agency will calculate the quote for you.All information will be kept completely confidential and will be used only for quote purposes.
HOWEVER, NO COVERAGE IS BOUND AND THE QUOTE
MAY BE SUBJECT TO OTHER UNDERWRITING CRITERIA.
All Items indicated with a * are
required to provide an accurate quote.
Personal Information Owner's Name: * Current Insurance Company:(enter none, if no insurance
currently) Boat Information
*
Watercraft type Equipment List - click all that apply VHF radio Depth finder Approved safety course Radar or GPS or Loran Halon System Hand held Fire Extinguishers # of extinguishers Alarm System Driver Information |
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| First Driver | Second Driver | |
| Name: * | ||
| Occupation: | ||
| Date of Birth: * | ||
| Marital Status: * | ||
| Years Boating Experience: * | ||
| Accidents/Violations (auto/boat): * | ||
| Other claims or losses * | ||
| How would you like to be contacted? * | If other, please specify | |
| Miscellaneous information or comments | ||
| for a quote to clear form and start over | ||
When completed, click on Submit Form ONE time and we will forward your quote to you in the form you have requested. If you have any questions, please feel free to contact us at 603-382-9211 or 800-295-9211
Copyright © 1998-2003 The Joseph S. Hills Agency, Inc. Last modified: June 22, 2004 |