Watercraft After Hours Claim Form

Please complete the following form for any after-hours watercraft claims.

Claim Information:

*Required Information

Your Name: *
Provide your policy number and boat or your address information.
Policy Number:


Street Address:
Zip Code: (12345 or 12345-1234)
Insurance Company: *
Home Phone: * (10 digit)
Cell Phone: (10 digit)
Date of Loss: *   mm/dd/yy
Time: *   hh:mm (12:00, 3:22; etc.)   a.m.   p.m.
The loss occurred in (body of water):*
Details of the Accident:*
Was anyone injured?*
Was there damage to any other
boat or property?*
Where is the boat now?*
<<See packet from Fitts for indication of email addresses for form submission>>

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