List Special Equipment & Values
(i.e., stove, refrigerator, special features, etc.)
R.V. #1
COVERAGES:
Limits of Liability:
$20/40 BI / 15 PD
$25/50 BI / 25 PD
$50/100 BI / 50 PD
$100/300 BI / 100 PD
$300,000 CSL
$500,000 CSL
Comprehensive & Collision:
NO Coverage
$250 Deductible
$500 Deductible
$1000 Deductible
Do you want Medical Coverage?
Yes
No
Uninsured Motorists?
Yes
No
R.V. #2
INFORMATION
Year of vehicle:
Make & Model:
Type (mobile/motor home, trailer, etc.):
Length in Feet:
Annual Mileage:
Value $:
List Special Equipment & Values
(i.e., stove, refrigerator, special features, etc.)
R.V. #2
COVERAGES:
Limits of Liability:
$20/40 BI / 15 PD
$25/50 BI / 25 PD
$50/100 BI / 50 PD
$100/300 BI / 100 PD
$300,000 CSL
$500,000 CSL
Comprehensive & Collision:
NO Coverage
$250 Deductible
$500 Deductible
$1000 Deductible
Do you want Medical Coverage?
Yes
No
Uninsured Motorists?
Yes
No
Send my quotation via:
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