Brokerage Listing Questionnaire Form

    Who is your sales consultant? *

    Boat Owner(s) Information

    Owner Name (as appears on title)

    First Name *

    Middle Name

    Last Name *

    Owner Email Address *

    Owner Mobile Phone *

    Co-owner *

    Work Phone (if applicable)

    Home Phone (if applicable)

    Street Address

    Street Address Line 2

    City

    State

    Zip Code

    Trust Name/Date (if title is in a Trust)

    Trustee Name (if title is in a Trust)

    Boat Information

    Year *

    Manufacturer *

    Model *

    Length *

    Beam *

    Hull Serial Number *

    Boat Name (if applicable)

    Hailing Port (if applicable)

    Hull Color

    Fuel Capacity *

    Water Capacity *

    Holding Tank Capacity

    Engine Information

    Engine Make

    Engine Model

    Engine Horse Power

    Number of Engines

    Center Engine Serial Number (or single Engine)

    Port Engine Serial Number

    Starboard Engine Serial Number

    Engine Hours

    Does your boat include a GENERATOR?

    Does your boat include a TRAILER?

    Insurance Information

    Insurance Company Name

    Insurance Agent Name

    Insurance Company/Agent Phone Number

    Policy #

    Do you have a loan on your boat? *

    Are you the original owner? *

    If no, can you list the number of owners the boat has had?

    Do you have the TITLE for your BOAT in your possession?

    Enter official USCG number if documented

    Do you have the TITLE for your TRAILER in your possession? (If
    applicable)

    Comments

    Do you have a current state registration for your BOAT?

    Comments

    Do you have a current state registration for your TRAILER? (If
    applicable)

    Comments

    What State is your boat registered?

    What State is your trailer registered?

    Where is your boat currently located? (ie; marina, slip number, residence,
    storage, etc)

    Where are the keys to your boat located?

    Please enter any passwords or codes needed for marina.

    Has your boat had a recent marine survey?

    If yes, how long ago and can you provide B & E Marine with a copy?

    Does your boat have hull blisters and/or moisture in the hull or
    deck?

    If yes, please explain

    Has your boat had any recent mechanical or structural repairs?

    If yes, please explain

    Does your boat have any remaining factory warranty?

    If yes, what is the expiration date or explain?

    Does your boat have any transferable extended protection?

    If yes, who is the provider and what is the expiration date?

    Does everything on your boat work properly?

    If no, please explain

    Is there anything else we should know about your boat?

    If yes, please explain

    Other (please specify)

    Please mark all SAFETY ITEMS included with your boat

    Other (please specify)

    Please mark all GENERAL features included with your boat?

    Other (please specify)

    Please mark all HEAD/SHOWER features included with your boat

    Other (please specify)

    Please mark all GALLEY/SALON features included with your boat

    Other (please specify)

    Please mark all functioning ELECTRONICS/NAVIGATION EQUIPMENT included with
    your boat

    Other (please specify)

    What type of shore power does your boat have?

    Would you like our service department to contact you for an estimate for any
    repairs you would like completed?

    If yes, what repairs?

    What dollar amount would you like to net on your boat?

    Please mark all CANVAS OPTIONS included with your boat


    Signature *

    Date