Watercraft and Boat Claim Form

1-888-697-6542

Please complete the following form for any after-hours watercraft claims.

*Required Information

Your Name: *
Provide your policy number and boat or your address information.
Policy Number:
Boat:
Or:
Street Address:
City:
State:
Zip Code:	(12345 or 12345-1234)

Insurance Company: *
Home Phone: *	(10 digit)
Cell Phone:	(10 digit)
Date of Loss: *	mm/dd/yy
Time: *	hh:mm (12:00, 3:22; etc.) a.m. p.m.
The loss occurred in (body of water):*
City:*
State:*
Details of the Accident:*
Was anyone injured?*
Was there damage to any other boat or property?*
Where is the boat now?*

<<See packet from Fitts for indication of email addresses for form submission>>