Blue Dog RV | Tobin Agency

Type of Insurance*

Dealer's Information

Dealer Name*

Salesperson Name*

How would you like us to get in touch with the RV Quote?

Phone
Email
Customer Waiting

How would you like us to get in touch with the RV Quote?

Phone
Email

How would you like us to get in touch with the Quote?

Phone
Email

Do you have the Bill of Sale?*

Yes
No

Please Upload the Bill of Sale*

Drop files here or

Max. file size: 64 MB.

Marital Status*

Date of Birth*

Email Address*

Phone Number*

Owner's Information

First Name*

Last Name*

Phone Number*

Email Address*

Mailing Address*

City*

State*

Zip Code*

Date of Birth*

Marital Status*

Spouse Full Name*

Spouse Date of Birth*

Vehicle Information

Year*

RV Type*

Make/Manufacturer*

Model*

Length of RV*

Width of RV*

Purchase Price*

If new, include tax, title & all fees

Purchase Price*

Purchase Information*

New
Used

Date of Purchase*

Travel Trailer Vehicle Usage*

Tow
Stationary

Campground Name & Site Number

Are there any attachments to the unit? i.e. sunroom, porch, deck*

Yes
No

Type of attachment(s) and dimensions:*

Do you have any unattached structures? i.e. shed, gazebo, detached deck*

Yes
No

Type of unattached structure(s) and approximate value:*

Park Model Address Information

Location Address*

City*

State*

Zip Code*

Is this location in a campground?*

Yes
No

Stationary Trailer Address Information

Location Address*

City*

State*

Zip Code*

Is this location in a campground?*

Yes
No

Other Address Information

Is this unit stationary in a campground?*

Yes
No

Is your registration address the same as your mailing address?*

Yes, same address
No, different address

Registration Address*

City*

State*

Zip Code*

Is the location of your unit the same as your residence?*

Yes, same address
No, different address

Unit Location Address*

City*

State*

Zip Code*

Underwriting Questions

Do you currently have insurance on this property?*

Yes
No

Is this your primary residence?*

Yes
No

Will the unit be rented out for a fee?*

Yes
No

Underwriting Questions

During the past 3 years have you had any accidents or violations?

Yes
No

Please explain the incident(s).

Will this be your full time residence 5 or more months per year?

Yes
No

Will this be used for any business purposes or rented to others for a fee?

Yes
No

Do you intend to ever tow this trailer?

Yes
No

Will this trailer be blocked and/or skirted?

Yes
No

Just a Few More Questions

This part can save you money

Is it equipped with airbags?

Yes
No

Is it equipped with anti-lock brakes?

Yes
No

Is it equipped with an audible anti-theft device?

Yes
No

Are you a member of an RV association or manufacturers club?

Yes
No

Do you have a commercial driver's license (CDL)?

Yes
No

Have you taken a defensive driving course?

Yes
No

Do you own a home?

Yes
No

Lien Holders Information

Lien Holder Name

Mailing Address

City

State

Zip Code

Additional Information

Do you currently have flood insurance?

Yes
No

Are you interested in receiving a quote for flood insurance?

Yes
No

How did you hear about us?

GAP Provided?*

Yes
No

Comments / Questions

Disclaimer*

Many states now permit the use of insurance scoring in determining RV insurance premiums. Your insurance score is a number based on the information contained in your credit report. Many of the companies, which we represent, use consumer reports, Application information, driving history and claims history to determine the most favorable rate. By submitting this quote request you are authorizing our agency and/or our companies access to these reports for this purpose.

I have read the disclaimer

Disclaimer*

Many states now permit the use of insurance scoring in determining insurance premiums. Your insurance score is a number based on the information contained in your credit report. Many of the companies, which we represent, use consumer reports, Application information, driving history and claims history to determine the most favorable rate. By submitting this quote request you are authorizing our agency and/or our companies access to these reports for this purpose.

I have read the disclaimer

Disclaimer*

Many states now permit the use of insurance scoring in determining RV insurance premiums. Your insurance score is a number based on the information contained in your credit report. Many of the companies, which we represent, use consumer reports, Application information, driving history and claims history to determine the most favorable rate. By submitting this quote request you are authorizing our agency and/or our companies access to these reports for this purpose.

Submission of this quote request assures us that you have advised your customer that an insurance score, obtained from a credit report, may be used to determine the best rate available.

I have read the disclaimer

Comments

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