Port City Marine Services

Survey Request

Vessel Owners and Buyers:
Please use the following form to send in a survey request.
You should receive a reply within two business days.

Name:
Address:
City and State:
Zip Code :
Email :
Phone (optional):
Boat Name :
Boat Type :
L.O.A. :
Location of Boat:
Type of Survey Needed:
Comments:


Click on the link below to download the Contract of Services and Scope of Survey. Complete and fax to: (251) 973-2776

Claim Form

This is a secure form for insurance companies
requesting claims service.


Company Requesting Claim:
Company Address:
Company Phone:
Company FAX:
Person Requesting Services:
Email Address:
Company Code:
Insured's Data
Insured Name:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Claim Number:
Policy Number:
Hull Limits:
Hull Deductible:
Engine Limits:
Engine Deductible:
Trailer Limits:
Trailer Deductible:
Personal Property Limits:
Personal Property Deductible:
Boat Manufacturer:
Boat Model:
Model Year:
HIN Number:
Engine Manufacturer:
Engine Model:
Engine Model Year:
Vessel Name:
Boat Location:
Boat Location Address:
Contact Name:
Contact Phone Number:
Date of Loss:
Location of Loss:
Description of Loss:
Special Instructions :