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Grand Banks

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YACHT INSURANCE EXCLUSIVELY FOR GRAND BANKS® YACHT OWNERS

PRODUCER INFORMATION
Broker Code
460201-0
Broker Phone Number
(888) 785-2878
Submission Date
03/30/2017
Broker Name
Wells Fargo Insurance Services USA, Inc.
Broker Fax Number
(206) 731-1209
Contact Name
Brenda Davis
Contact Number
(206) 731-1330
Customer Email Address:
Customer Phone:

INSURED INFORMATION (please include your email address and phone number above)
Beneficial Insured Name (Last, First):
Address:
City:   State or Country:   Zip Code:
Chartering? Yes   No   If yes, Number per Year:   Total years experience:
Corporate Insured Name (if any):
Policy Effective Date:
(mm/dd/yyyy)

Prior Yacht(s) Owned
DO NOT USE QUOTES IN FIELDS - NUMBERS ONLY
Length Manufacturer
Loss History (if none, please indicate):


YACHT INFORMATION
Year Built: Length: Manufacturer Name: Grand Banks
Yacht Name: Type:
Home Port
City: State (or Country): Construction Material:
Engine Manufacturer: Total HP:
Survey Available? Yes No   Last Date: Number of Personal Watercraft:

Tender(s):
DO NOT USE QUOTES IN FIELDS - NUMBERS ONLY
Year Length Manufacturer

Navigation Limits:
Captain:   Full time   Part time   None  Name of Captain (if applicable):
Number of Crew:
Full time:
Part time:
Insured Value Requested: 
Liability Limits Requested: 
Leinholder/Lender:
Was this insurance recommended by a Grand Banks Yacht Dealer? If so, which one and by whom?
ADDITIONAL INFORMATION