Watercraft Quote 

Boat/Watercraft Quote
 
Full Name:  
Day Telephone:  
Street Address:  
Eve Telephone:  
City, State & Zip:  
Fax:  
E-Mail Address:  
Best Time To Reach You:

Current Insurance Information
Insurance Company Name:
(NOT Insurance Agency/Broker) 
Policy Exp. Date:  
Premium Amt:  
Term:  
How long with current?  

Vessel Description:
Year, Make, Model yr    mk    model  
 Length and Value    $  
 Horsepower  
 Maximum speed  
 Type of Hull  
 Body style  

Power Description:
Engine 1 Engine   Year/Make/Model
   Engine Value, Type
$
Engine 2 Engine   Year/Make/Model
   Engine Value, Type
$

Trailer Description:
Trailer   Year/Make/Model

Driver Information
 Primary Driver Name
 License #, Age
    ,
 Date of Birth
 Social Security Number
 Years Boating experience
 Any motor vehicle citations within the past 3 years?
 Requested Limits of liability
 Original Owner
 Approved Safety Course completion

Any additional comments or information that might be helpful in your quote:


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PO Box 306
1404 South Main
Farmville, VA 23901
Phone: 434-392-5405
Email: info@harwoodins.com

 

 

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Community Involvement:

  • Board of Trustees, Hampden Sydney College 2000 – 2013
  • Board of Trustees Randolph-Macon Academy 2002 - 2004
  • Board of Directors, 1st National Bank of Farmville/1st Virginia Bank 1980-1995
  • Virginia Commission of State and Local Governments’ Responsibility and Taxing Authority 1995 – 1996*
  • Commission on the Future of Higher Education in Virginia*
  • Tobacco Indemnification and Community Revitalization Commission 2005 – 2009**
  • Chairman, Prince Edward County United Way, 1988
  • Chairman, Poplar Hill Community Development Authority 2000 – 2004
  • President, Randolph-Macon Academy Alumni Association 2002 – 2004
  • YMCA
  • Farmville Area Chamber of Commerce
  • Farmville Jaycees
  • Farmville Rotary Club
  • Mission work in Honduras
  • Farmville Lions Club
  • Farmville Masonic Lodge
  • Longwood College Center For the Visual Arts
  • Southside Virginia Red Cross
  • Active annually in state and federal lobbying for client and industry advocacy.
  • Veterans of Foreign Wars, Life member
  • Insurance Education for Habitat For Humanity Recipients

 

*Appointed by Governor George Allen
**Appointed by Governor Mark Warner