Watercraft Insurance

No coverage is bound until you are contacted by one of our representatives.

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Vessel Description
Year:
Make:
Model:
Length:
Value:
Hull ID Number:
Body Style:

Power Description
Engine #1
Year:
Make:
Model:
Value:
Type:
Engine #2
Year:
Make:
Model:
Value:
Type:

Trailer Description
Year:
Make:
Model:
Value:

Additional Equipment Description
Item #1:
Item #1 Quantity:
Item #1 Value:
Item #2:
Item #2 Quantity:
Item #2 Value:
Item #3:
Item #3 Quantity:
Item #3 Value:
Item #4:
Item #4 Quantity:
Item #4 Value:
Item #5:
Item #5 Quantity:
Item #5 Value:
Item #6:
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Item #6 Value:
Item #7:
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Item #7 Value:
Item #8:
Item #8 Quantity:
Item #8 Value:
Item #9:
Item #9 Quantity:
Item #9 Value:
Item #10:
Item #10 Quantity:
Item #10 Value:

Magnolia Special Needs Planning

102 Versailles Boulevard Suite 120

Lafayette, LA 70501

Phone: (337) 254-3103

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Fax: (337) 234-0658

www.micahmoscovis.com

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