Insurance Nation

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RVs

Customer Information

1. First Name:(required)
2. Last Name:(required)
3. Sex: Male Female (required)
4. Email:(valid email required)
5. Date of Birth:(required)
6. Marital Status: Single Married Other (required)
7. Phone Number:(required)
8. Home Address:
9. Primary Residence: Own Home/Condo Own Mobile Home less than 10 yearas old Rent Live with Parents Other
10. If Other:
11. Automobile Driver License Status:

Driving record (prior 35 months)

1. No/Nature of Tickets (all vehicles):
2. No/Nature of AF/ANF Auto/Motorcycle Accidents:

Motor Home/Travel Trailer Information

1. Motor Homes: Class A Class B Class C Bus Conversion (required)
2. Travel Trailers: Conventional Pop-Up Fifth Wheel Truck Camper (required)
3. Year:(required)
4. Make:(required)
5. Model:(required)
6. Rating Base:(required)
7. Garaging Zip:(required)
8. Anti-Theft Device: No Yes (required)
9. Anti-Lock Brakes: No Yes (required)
10. Vehicle Use: < 30 Days 30-60 Days > 150 Days (required)
11. Primary Residence: Non-Traveling Traveling (required)

Underwriting Information

1. Garaging Zip:(required)
2. Other policies(5% Discount): Automobile Boat Motorcycle RV Snowmobile (required)
3. Names of Co-Owners:
4. Names of Regular Operators:
5. Names of Household Resident Operators:

Coverage Information

1. Physical Damage Coverage: Total Loss Replacement (New RVs Only) Agreed Value Actual Cash Value
2. Physical Damage Deductibles: $100 $250 $500 $1000 $2500 (required)
3. Liability Coverage Limits : $100 $300 $500 $1000 Other
4. UM/UIM Coverage Limits : No Coverage $100 $300 $500 $1000 Other (required)
5. Medical Payments Coverage: No coverage $1000 $2500 $5000 $10,000 (required)
6. Emergency Expense Coverage: $750 (included) $2000 $2000 (required)
7. Vacation Liability: $10,000 $500,000 (required)
8. Personal Effects Coverage :(required)
9. Deluxe Package: No Yes (required)
10. Roadside Assistance: No Yes (required)
11. Full-Timers Package: $50,000/$100,000 $100,000/$300,000 $250,000/$500,000 $300,000 CSL $500,000 CSL (required)
12. Trailer Coverage :(required)
13. Additional Information:

 

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