Completion of this form is for informational purposes only, and is just an estimate. This WILL NOT result in a new policy, or change to an existing policy.
This quote is an estimate based on a single family home with standard central heating
APPLICANT INFORMATION
First Name
Last Name
Address
Phone
City
Phone 2
Province
E-Mail
Postal Code
Contact Method
Phone Email
INSURANCE HISTORY
Has your insurance ever been cancelled?
Yes No
Are you presently insured? If yes, what company?
Policy Number
Expiry Date
Number of claims in the last 5 years
GENERAL INFORMATION
Is your RV permanently located at an RV Park, Campground, owned or rented property ?
Yes No
If your RV is permanently sited, is your RV blocked and skirted ?
Yes No
Do you occupy your RV as a residence, whether on a full time, part time basis or for work purposes ?
Yes No
Are you over 50 Years of age ?
Yes No
PLEASE PROVIDE A DESCRIPTION OF YOUR RV
Type of RV
Year Manufactured:
Make / Manufacturer
Length of RV
Please advise your purchase price of the RV
Value:
Please advise the current selling price of your RV
Value:
Please advise what a brand new unit (current year model) would cost
