Please fill out this form completely and submit for your Personalized Price Quote.  RV America Insurance will Email and/or Fax you a Price Quote within 24 hours. (Monday - Friday) 

 

Principal Operator
Married Yes   No
Date of Birth
Street Address
City
County
State
Zip
Phone
Fax We'll fax it the same day!
E-mail Quotes returned in 24 hours

 

Please answer each of the following:
(Required for quotation)

     Used for recreational purposes only? Yes   No
     Are you a home owner? Yes   No
     Is it used as a full-time residence?  Yes   No
     If full-time residence, is it stationary?
         (Describe in Additional Comments)		 Yes   No
     Used in connection with business?    
         (Describe in Additional Comments)		 Yes   No
     Member of an RV Association? Yes   No
     Tickets or at-fault accidents - last 3 years?
         (Please detail below)		 Yes   No


  Please detail any tickets or accidents:  


Type of RV:
    Motor Home   Trailer  Camper Van  5th Wheel   Motor Home  Trailer   

Do you  already own this RV? Yes   No
Are you (or will you be) the original owner? Yes   No
Are you purchasing this RV from a dealer? Yes   No
Are you shopping for a new/used RV now? Yes   No
Year:
Length:
Make/Model:
Current Market Value: (You may use commas)
Original Purchase Price: (Commas OK here too)
Deductible Option: $250
$500
$1,000
$2,500
Liability limits you prefer:
(Motorhome Only)   
$100/300/50
$250/500/100
$1 Million
Would you please tell us the name of your Dealer or Purchasing Service?
(This allows us to help you finalize the transaction.)


Any additional comments?  Describe Business or Stationary Use:

Thank You. If you are submitting on a weekend, you should expect
to receive your quotation no later than Monday evening.