Name

Email Address

Address

Phone

Vessel Type Vessel Type Power boat Sailboat Other

Builder

Year and Model

Length

Hull Material

Engine Engine Single Twin Outboard

Fuel Fuel Gasoline Diesel Electric Other

Engine Manufacturer and Model

Engine Hours (approximate)

Physical Location of the Boat - Marina Name

Condition Condition Bristol Good Fair Poor

Your Estimate of Current Value

How long have you owned this vessel?

Have you had a survey or appraisal completed in the last four years Have you had a survey or appraisal completed in the last four years Yes No

Vessel’s Insured or Appraised Value

When was the vessel last hauled out for inspection or bottom paint?

Please provide any additional information you’d like us to know about your boat