A Full Service Insurance Company - Westwood, NJ
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Name*
Address
City* State* Zip:
Please supply either a Daytime or Evening Phone Number & best time to call
Day Time Number: (please include area code)
Evening Number: (please include area code)
Best Time To Call*
E-mail:
Marital Status*
Current Carrier?* How Long? yrs Policy Expires?
SS# Drivers Lic#
Number of years experience Member of any boating association
Purchase price: Loss Payee

Loss Payee
(if applicable)

Name:
Address:
City: State: Zip:
Balance Due:
Has insurance ever been declined: If Yes explain,
List and detail any losses or claims

Watercraft Information

Year: Length: Model: Builder:
Hull Identification # Name of Boat:
Hull Type Hull Material other
Engine Year: Manufacturer: How many: HP each:
Max Speed (MPH): Engine(s) S#
Trailer Yr: Lngth: Mfg: S#
Tender Yr: Lngth: Mfg: S#
Tender's Motor Yr: Lngth: Mfg: S#

Equipment

Loran Radar Halon
GPS Depth Finder VHF
Other:

  Navigation

Chesapeake Bay Trib. Inland Water Specify Waters
Atlantic Coast between and
Vessel will be laid up Where:
(Vessel in excess of 24' ONLY) Ever transported overland If yes, how many miles?
Chartered   Ever used for water skiing?

Coverage

Effective Period From: to
  Values Deductible Premium
Hull and Machinery
Outboard Motor
Equipment
Tender and its Motor
Trailer
Liability
Medical Payments
Overland Transp. (miles)
Uninsured Boaters
Personal Effects
Assistance/Towing
Total Premium

Johl & Company Insurance - Established by John Johl in 1963
Copyright 2000-2008, Johl & Company, All rights reserved
No portion of this website may be copied or linked to without the expressed permission of its owner
Licensed in the States of New Jersey - New York - Pennsylvania - Connecticut