<!-- BOF: ./personal-templates/show.body -->
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<HTML>
<HEAD>


<META NAME="description" CONTENT="Property and Casualty Insurance for your Business, Home and Family">
<META NAME="Keywords"    CONTENT="Insurance, North,Pittsburgh, Property, Casualty,"> 


<!-- business -->


<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=ISO-8859-1">
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<TITLE>Boat Rating Worksheet</TITLE></head>
<BODY  BGCOLOR="#FFFFFF"
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MARGINHEIGHT="0" MARGINWIDTH="0" LEFTMARGIN="0" TOPMARGIN="0" RIGHTMARGIN="0" BOTTOMMARGIN="0"

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>

  
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<TABLE WIDTH=100% HEIGHT=100% BORDER=0 CELLPADDING=0 CELLSPACING=0>

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							<TR>
								<TD WIDTH=228 HEIGHT=32>
									
									<a href="index.html" onMouseOver="document.images['img6'].src='widgets/gen_51.1.gif'" onMouseOut="document.images['img6'].src='widgets/gen_50.1.gif'"><img src="widgets/gen_50.1.gif" alt="Welcome" name="img6" border="0"></a><br>
									<a href="gpage.html.html" onMouseOver="document.images['img122'].src='widgets/gen_81.1.gif'" onMouseOut="document.images['img122'].src='widgets/gen_80.1.gif'"><img src="widgets/gen_80.1.gif" alt="Homeowners Intro" name="img122" border="0"></a><br>
									<a href="form3.html.html" onMouseOver="document.images['img95'].src='widgets/gen_84.1.gif'" onMouseOut="document.images['img95'].src='widgets/gen_83.1.gif'"><img src="widgets/gen_83.1.gif" alt="Homeowners Quote" name="img95" border="0"></a><br>
									<a href="gpage.html" onMouseOver="document.images['img126'].src='widgets/gen_69.1.gif'" onMouseOut="document.images['img126'].src='widgets/gen_68.1.gif'"><img src="widgets/gen_68.1.gif" alt="Auto Insurance" name="img126" border="0"></a><br>
									<a href="form2.html.html" onMouseOver="document.images['img76'].src='widgets/gen_86.1.gif'" onMouseOut="document.images['img76'].src='widgets/gen_85.1.gif'"><img src="widgets/gen_85.1.gif" alt="Auto Quote" name="img76" border="0"></a><br>
									<a href="gpage1.html" onMouseOver="document.images['img128'].src='widgets/gen_89.1.gif'" onMouseOut="document.images['img128'].src='widgets/gen_88.1.gif'"><img src="widgets/gen_88.1.gif" alt="Business Insurance" name="img128" border="0"></a><br>
									<a href="gpage3.html" onMouseOver="document.images['img132'].src='widgets/gen_96.1.gif'" onMouseOut="document.images['img132'].src='widgets/gen_95.1.gif'"><img src="widgets/gen_95.1.gif" alt="Life Insurance" name="img132" border="0"></a><br>
									<a href="gpage4.html" onMouseOver="document.images['img134'].src='widgets/gen_98.1.gif'" onMouseOut="document.images['img134'].src='widgets/gen_97.1.gif'"><img src="widgets/gen_97.1.gif" alt="Health Insurance" name="img134" border="0"></a><br>
									<a href="gpage2.html" onMouseOver="document.images['img130'].src='widgets/gen_92.1.gif'" onMouseOut="document.images['img130'].src='widgets/gen_91.1.gif'"><img src="widgets/gen_91.1.gif" alt="Long Term Health Care" name="img130" border="0"></a><br>
									<a href="form1.html" onMouseOver="document.images['img50'].src='widgets/gen_66.1.gif'" onMouseOut="document.images['img50'].src='widgets/gen_65.1.gif'"><img src="widgets/gen_65.1.gif" alt="Motorcycle Insurance" name="img50" border="0"></a><br>
									<a href="form.html" onMouseOver="document.images['img12'].src='widgets/gen_63.1.gif'" onMouseOut="document.images['img12'].src='widgets/gen_62.1.gif'"><img src="widgets/gen_62.1.gif" alt="Boat Insurance" name="img12" border="0"></a><br>
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									<a href="about.html.html" onMouseOver="document.images['img7'].src='widgets/gen_54.1.gif'" onMouseOut="document.images['img7'].src='widgets/gen_53.1.gif'"><img src="widgets/gen_53.1.gif" alt="About" name="img7" border="0"></a><br>
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												<!-- BOF: ./personal-templates/simple/business/form/html -->
<!-- BOF: ./personal-templates/simple/personal/form/html -->


<center><table border="0"><tr><td>


<font face='Arial' size='+1' color='#000000'>

Boat Rating Worksheet

</font>


<br>
<SCRIPT LANGUAGE="JavaScript">
function validate(){
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        valid=true;
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if (document.forms[0].field_33.value==""){ valid=false; };


if (valid==false) { 
		alert('You did not fill all required fields!'); 
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return valid;
}
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<form name="questionary" action="http://lobsterwebdesign.com:8080/servlet/psoft.customform.CustomForm" method="post">
<input type="hidden" name="form_id" value="12">
<input type="hidden" name="user_id" value="11">
<input type="hidden" name="title" value="Boat Rating Worksheet">

<input type="hidden" name="name" value="email1.html">


<input type="hidden" name="order" value="16 33 17 18 d40 39 41 19 20 21 22 23 24 25 26 27 28 29 30 31 42 43 44 45 46 47 48 49 ">
<input type="hidden" name="submit_url" value="http://npib.net/onsubmit1.html">
<input type="hidden" name="error_url" value="http://npib.net/onerror1.html">
<table border="0">

<input type="hidden" name="name_16" value="Name">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Name

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<input type="text" name="field_16">


</td></tr> 

<input type="hidden" name="name_33" value="Email">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Email

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<input type="text" name="field_33">


</td></tr> 

<input type="hidden" name="name_17" value="Address">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Address

</font>


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<textarea name="field_17" rows="4" cols="30"></textarea>


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<input type="hidden" name="name_18" value="How Long at Address">
<tr><td>


<font face='Arial' size='2' color='#000000'>

How Long at Address

</font>


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<input type="text" name="field_18">


</td></tr> 

<input type="hidden" name="name_40" value="Date of Birth">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Date of Birth

</font>


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<select name="field_m_40" size="1">
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<option>Apr
<option>May
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<input type="hidden" name="name_39" value="Married">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Married

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<input type="hidden" name="name_41" value="Occupation">
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<font face='Arial' size='2' color='#000000'>

Occupation

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<input type="text" name="field_41">


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<input type="hidden" name="name_19" value="Own">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Own

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<input type="hidden" name="name_20" value="Rent">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Rent

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</td></tr> 

<input type="hidden" name="name_21" value="Year">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Year

</font>


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<input type="text" name="field_21">


</td></tr> 

<input type="hidden" name="name_22" value="Length">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Length

</font>


 </td><td>


<input type="text" name="field_22">


</td></tr> 

<input type="hidden" name="name_23" value="Make">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Make

</font>


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<input type="text" name="field_23">


</td></tr> 

<input type="hidden" name="name_24" value="Model">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Model

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<input type="text" name="field_24">


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<input type="hidden" name="name_25" value="Horsepower">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Horsepower

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<input type="text" name="field_25">


</td></tr> 

<input type="hidden" name="name_26" value="Max Speed">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Max Speed

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<input type="text" name="field_26">


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<input type="hidden" name="name_27" value="Hull Type">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Hull Type

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<input type="text" name="field_27">


</td></tr> 

<input type="hidden" name="name_28" value="Value of Boat">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Value of Boat

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<input type="text" name="field_28">


</td></tr> 

<input type="hidden" name="name_29" value="Motor">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Motor

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<input type="text" name="field_29">


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<font face='Arial' size='2' color='#000000'>

Trailer

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<input type="text" name="field_30">


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<font face='Arial' size='2' color='#000000'>

Location of Dock

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<input type="text" name="field_31">


</td></tr> 

<input type="hidden" name="name_42" value="Years Expirenced">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Years Expirenced

</font>


 </td><td>


<input type="text" name="field_42">


</td></tr> 

<input type="hidden" name="name_43" value="Current Boat Insurance">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Current Boat Insurance

</font>


 </td><td>


<input type="text" name="field_43">


</td></tr> 

<input type="hidden" name="name_44" value="Safty Course">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Safty Course

</font>


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 <input type="radio" name="field_44" value="Yes">Yes <input type="radio" name="field_44" value="No">No


</td></tr> 

<input type="hidden" name="name_45" value="Driving Record for Past 3 Years">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Driving Record for Past 3 Years

</font>


 </td><td>


<textarea name="field_45" rows="4" cols="30"></textarea>


</td></tr> 

<input type="hidden" name="name_46" value="Boat Claims for Past 3 Years">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Boat Claims for Past 3 Years

</font>


 </td><td>


<textarea name="field_46" rows="4" cols="30"></textarea>


</td></tr> 

<input type="hidden" name="name_47" value="Addtional Equipment">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Addtional Equipment

</font>


 </td><td>


<textarea name="field_47" rows="4" cols="30"></textarea>


</td></tr> 

<input type="hidden" name="name_48" value="Auto Insurance Carrier">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Auto Insurance Carrier

</font>


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<input type="text" name="field_48">


</td></tr> 

<input type="hidden" name="name_49" value="Home Insurance Carrier">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Home Insurance Carrier

</font>


 </td><td>


<input type="text" name="field_49">


</td></tr> 

</table>

 
<input type="submit" onClick="return validate()"> <input type="reset">

</form>
</td></tr></table></center>
<!-- EOF: ./personal-templates/simple/personal/form/html -->

<!-- EOF: ./personal-templates/simple/business/form/html -->
<br>
<br>
<FONT FACE="verdana, arial, helvetica" SIZE="1">
<center>
<nobr>|<a href="index.html">Welcome</A>|</nobr>

<nobr>|<a href="gpage.html.html">Homeowners Intro</A>|</nobr>

<nobr>|<a href="form3.html.html">Homeowners Quote</A>|</nobr>

<nobr>|<a href="gpage.html">Auto Insurance</A>|</nobr>

<nobr>|<a href="form2.html.html">Auto Quote</A>|</nobr>

<nobr>|<a href="gpage1.html">Business Insurance</A>|</nobr>

<nobr>|<a href="gpage3.html">Life Insurance</A>|</nobr>

<nobr>|<a href="gpage4.html">Health Insurance</A>|</nobr>

<nobr>|<a href="gpage2.html">Long Term Health Care</A>|</nobr>

<nobr>|<a href="form1.html">Motorcycle Insurance</A>|</nobr>

<nobr>|Boat Insurance|</nobr>

<nobr>|<a href="gpage5.html.html">Company Bios</A>|</nobr>

<nobr>|<a href="about.html.html">About</A>|</nobr>

<nobr>|<a href="contact.html">Contact Us</A>|</nobr>
</center>
</font>
<br>
<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">

<a href="http://www.psoft.net" target="_blank"><img src="widgets/ss_button.gif" border="0"></a>

<br><font face="helvetica,verdana, arial" size="1"><a href="http://www.psoft.net"><font face="helvetica,verdana, arial" size="1">Copyright 1999-2002. Positive Software Corporation. All rights reserved</font></a></font>

</td></tr></table></center>
</TD>
										</TR>
                                        				</TABLE>
								</TD>
							</TR>
						</TABLE>		
					</td>
                                        <TD WIDTH=6 HEIGHT=100% background="widgets/gen_49.1.gif">
												<IMG SRC="widgets/spacer.gif" WIDTH=6 HEIGHT=1></TD>
				</tr>
			</TABLE>
		</td>
	</tr>
<!-- End Menu-->

<!-- Begin Last-->
	
<!--End Last-->
</table>
<!-- EOF: ./personal-templates/simple/business/layout/l28.layout -->

    
<!-- BOF: ./personal-templates/simple/themes.show.body -->


<!-- EOF: ./personal-templates/simple/themes.show.body -->

</body>
<!-- BOF: ./personal-templates/simple/themes.show.end -->


<!-- EOF: ./personal-templates/simple/themes.show.end -->


</html>
   

<!-- EOF: ./personal-templates/show.body -->