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| by W.R. Hodgens Marine Insurance, Inc. |
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| Please complete the following Charter Application Form in as much detail as possible to assure we can provide you with the most competitive insurance rate, or phone us at 1-800-990-WAVE (9283) for an immediate quote. |
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| CARIBBEAN BOAT and YACHT I N S U R A N C E |
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| from W.R. Hodgens Marine Insurance, Inc. | |
| 2015 SW 20th St., Suite 100 | Fort Lauderdale, FL 33315 |
| Ph: 954-523-6867 | Fax: 954-523-6488 |
| Toll Free USA: 800-990-WAVE (9283) | |