RV Quote Request Form First Name Last Name Email Address Phone Number Date of Birth Mailing Address Zip What type of RV do you own? —Please choose an option—Class A MotorhomeClass B MotorhomeClass C MotorhomeOther type of MotorhomeConventional5th WheelPop UpTruck CamperToy Hauler & Horse TrailerCargo/Utility & Horse Trailer Year Make Model Primary Use —Please choose an option—Pleasure UsePrimary ResidenceTaken to and From work locationsUsed at a work locationOnly vehicle in household registered for street use Primary Zip Location Was the vehicle purchased or leased? —Please choose an option—PurchasedLeased What year was this RV acquired Equipped with an anti theft device? —Please choose an option—NoneActive AlarmPassive AlarmRecovery DevicesActive/Recovery DevicesPassive/Recovery Devices Are you the original owner of the RV? YesNo Market Value of RV Gender MaleFemale Marital Status —Please choose an option—Single/SeparatedMarried/Civil Union/Domestic Partnership/Widowed Residency Primary Residence —Please choose an option—Own House/CondominiumOwn Manufactured HomeRentOther Moved in the last 2 months? —Please choose an option—NoYes - Moved within the U.S.Yes - Moved from outside the U.S. Driving History Driver's License Status —Please choose an option—ValidPermitSuspendedNot LicensedForeign Driver's License Years of RV Operating Experience Accidents, Violations, and Claims As a driver in the last 3 years, have you had any of the following regardless of fault (including automobile) Accidents, claims, or other damages you had to a vehicle? YesNo Tickets or Violations YesNo Insurance History Have you had at least 6 months of continuous RV insurance in the past 12 months? YesNo Additional Information When would you need coverage?
