Le Claire Insurance

J L Le Claire & Sons Insurance Agency

The Protection and Security you would expect from Family

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Travel Trailer Qoute

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Travel Trailer Qoute

Travel Trailer Insurance Quote Request Complete the following information if you would like to obtain a quote. Please understand this is not an application. All information provided on this information sheet is confidential and will be used solely for the purpose of developing a quote for you.
Named Insured
Last Name
First Name
Street Address
City
State
Zip Code
Phone Number
Fax Number
Email Address
Date of Birth
Social Security Number
Garaging/Storage Address - if different from above
Name of Location (If Storage Facility)
Street Address
City
State
Zip Code
Vehicle 1 Information
Year
Make
Model
Vin #
Cost New Value
Vehicle Type
Length
Purchase Date
Current Market Value
Use
Loss History
Ownership
Vehicle 2 Information
Year
Make
Model
Vin #
Cost New Value
Vehicle Type
Length
Purchase Date
Current Market Value
Use
Loss History
Ownership
Vehicle 3 Information
Year
Make
Model
Vin #
Cost New Value
Vehicle Type
Length
Purchase Date
Current Market Value
Use
Loss History
Ownership
Vehicle 4 Information
Year
Make
Model
Vin #
Cost New Value
Vehicle Type
Length
Purchase Date
Current Market Value
Use
Loss History
Ownership
Coverage Information
Adjacent Structures, i.e. Awnings. Satellite, etc. (Amount)
Vacation Liability
Towing/Roadside Assistance
Emergency Expense
Scheduled Medical Benefits	Yes No
Personal Property Amount (Actual Cash Value)
Personal Property Replacement Cost	Yes No
Total Loss Replacement Cost	Yes No
Are you the Original Owner of the Unit	Yes No
Full Timer Liability
Additional Living Expense (Only available with Full Timer Liability)
Deductible Information
Vehicle 1
Comp (theft)
Collision
Vehicle 2
Comp (theft)
Collision
Vehicle 3
Comp (theft)
Collision
Vehicle 4
Comp (theft)
Collision
Miscellaneous Information
Is the Travel Trailer used as a primary residence?	Yes No
Do you currently own a home?	Yes No
Do you currently have a Travel Trailer policy?	Yes No
Is or will the Travel Trailer be rented or leased?	Yes No
Is or will the Travel Trailer be used strictly for recreational purposes?	Yes No
Is or will the Travel Trailer be used in connection with any operator's business or profession?	Yes No
Is the Travel Trailer owned by two or more individuals residing in separate households?	Yes No
Current Insurance Company
Expiration Date
Current Premium
Questions or Comments

Travel Trailer Insurance Quote Request

Named Insured

Garaging/Storage Address - if different from above

Vehicle 1 Information

Vehicle 2 Information

Vehicle 3 Information

Vehicle 4 Information

Coverage Information

Deductible Information

Vehicle 1

Vehicle 2

Vehicle 3

Vehicle 4

Miscellaneous Information