Fishing Guide Insurance Questionnaire

Fishing Guide Insurance Questionnaire
Applicant's Name:*
Address:*
Mailing Address
Address (cont):*
Mailing Address - continued
Contact:*
Email*
Telephone:*
Website
Fax:
Applicant is:

IndividualPartnershipCorporationOther (specify)
Current Carrier:
Expiration Date:
Limits: ($)
Premium: ($)
Deductible: ($)
General Information
1. Do you provide guide services on the Great Lakes or other coastal waters? (If yes, you are not eligible for this program.)

YesNo
2. Date you need coverage:
3. In what state(s) do you conduct business?
4. How many years have you been in business?
5. Please describe all aspects of your operation:
6. What are the gross receipts from this operation?
7. How many boats are used in this operation?

8. Please complete the following for each boat used in this operation: