Port City Marine Surveyors, Donald J. (DJ) Smith, SAMS® AMS®, Mobile, Alabama, USA

Port City Marine Surveyors
Div. of Port City Marine Services, Inc.

Mobile, Alabama, USA
Service Areas Include:
Orange Beach, Alabama & Biloxi, Mississippi
Worldwide Service Available

Donald J. (DJ) Smith, SAMS® AMS®
Principal Marine Surveyor
Cell: 251-421-5426

Claim Form

This form is for insurance companies requesting claims service.

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:

Company Requesting Claim:

Go To Main Page.