COMPETITION VEHICLE/MARINE INSURANCE

"*" indicates required fields

INVENTORY SCHEDULE
Competition Vehicle
List Value of Vehicle ($)
List Vehicle Name or Identifying Marks
Provide Replacement Value ($)
 
Equipment (Tools, Spare Parts, etc.) - Description of all items over $2,500
List Value of Equipment – Over $2,500 ($)
List Serial Numbers or Identifying Marks
Provide Replacement Value ($)
 
Trailers - Description
List Value of Trailer ($)
List Serial Numbers or Identifying Marks
Provide Replacement Value ($)
 

Desired Deductibles

Deductible Amount:

Claims Experience

How did you hear about us ?
*Please provide past 5 year hard copy loss runs and description of any individual claim or reserve in excess of $10,000
*Completion of this form does not bind coverage