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  Client * * Name (First, Mid, Last, Sfx):    Date of Birth (mm/dd/yyyy):     /  *  /  E-Mail Address:    * Drivers License State: * Drivers License Number: * * * State:   City:   Apartment / Suite Number:   Street Address:    *   Address * Marital Status: Number of Years of Boat Ownership: Boating Experience: *   Experience * Number of Years Operating Boats: * Number of Prior Boating Claims:   Date of Last Claim: Required if there were losses, estimate if no exact date known / / Boating Courses:   United States Coast Guard:   * United States Power Squadron: * Other Courses:   *  Required Entry Postal Code:    * Residence Status: *
 

 
In connection with this insurance and to offer you an accurate quote, the insurance company may obtain or use a credit-based insurance score as part of the insurance underwriting process. Actuarial studies indicate that an insurance score is a good predictor of future claims, thus enabling the insurer to base their premiums on the actual risk. The information used to develop the insurance score comes from TransUnion or other similar companies. A credit-based insurance score will not impact your credit rating or credit score.

West Virginia Residents may request recalculation of your credit-based insurance score once every 12 months. 		 

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