|
Travel
Trailer Quote Form |
|
Please
provide the following information as accurate as possible.
Information provided will not be used for anything other than for the
purpose of this form. |
| Name: |
|
| Street
address: |
|
| City: |
|
| State: |
|
| Zip: |
|
| Phone: |
|
| E-Mail: |
|
| Date
of birth: |
|
Have
you had a bankruptcy
tax lien, judgment,
foreclosure, or repossession
in the last three years?: |
|
County
in which the travel
trailer is principally garaged: |
|
Do
you currently have
insurance on your travel
trailer?: |
|
| If
yes, with which company?: |
|
| Type
of travel trailer: |
|
| Year
Built: |
|
| Make: |
|
| Model: |
|
| Length: |
|
| Current
value: |
|
How
do you use your
travel trailer?: |
|
Does
your trailer have an
audible alarm?: |
|
What
deductible do you
want on comprehensive
coverage?: |
|
What
deductible do you
want on collision coverage?:
|
|
What
limits of liability
coverage do you want?: |
|
What
limits of personal
effects (personal items
inside your trailer such as
clothing, furniture, cooking
utensils, music, etc.) would
you like?: |
|
Are
you a member of
an RV club?: |
|
How
did you hear about
Budget Insurance
Offices, Inc.?: |
|
| Driver
#1 info: |
|
| Age: |
|
| Sex: |
|
| Marital
status: |
|
Do
you have any accidents,
violations, or tickets in the
last three years?: |
|
If
yes, list infractions,
and dates they occurred: |
|
| Driver
#2 info: |
|
| Age: |
|
| Sex: |
|
| Marital
status: |
|
Do
you have any accidents,
violations, or tickets in the
last three years?: |
|
If
yes, list infractions,
and dates they occurred: |
|
