Insuring Minnesota Presents:

Insurance Programs for Minneapolis Residents! Highest Insurance Discounts With Quality Service!

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Insuring Minnesota
20960 Holyoke Ave
Lakeville, MN 55044
Phone: 952-469-0425
Fax: 952-469-1881

E-Mail us at:
info@insuring
minnesota.com

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Low Cost Minneapolis RV Insurance Rates! FREE
QUOTES!
 
Minneapolis Motor Home
& Other RV Quote Form
One Simple Form - takes only 2-3 Minutes!


YOUR PERSONAL DATA:

Your Name:
Street Address:
City:
State: MUST be Minnesota!
Zip/Postal:
E-Mail (REQUIRED):
Phone:
Fax (optional):
 
Marital Status:
Single Married
Homeowner?
Yes No
 
Currently Insured?
(If yes, list carrier, and # of years
continuous. If no, type NONE)


DRIVER INFORMATION #1
Name: Birth date:
Sex: # Years U.S.
 Auto License:
Number & Type of Accidents within last 3 years: Number & Type of MINOR Cites within last 3 years:
Number & Type of MAJOR Cites within last 3 years: Minnesota
DL# & SS#:
Does Driver need
an SR22 FILING?
Yes No Comments or
Remarks?
 
DRIVER INFORMATION #2 (if none, leave blank)
Name: Birth date:
Sex: # Years U.S.
 Auto License:
Number & Type of Accidents within last 3 years: Number & Type of MINOR Cites within last 3 years:
Number & Type of MAJOR Cites within last 3 years: Minnesota
DL# & SS#:
Does Driver need
an SR22 FILING?
Yes No Comments or
Remarks?

R.V. #1 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. #1 COVERAGES:
Limits of
Liability:
$30/60 BI / 25 PD
$50/100 BI / 50 PD
$100/300 BI / 100 PD
$250/500 BI / 100 PD
 
Comprehensive
& Collision:
NO Coverage $250 Deductible
$500 Deductible $1000 Deductible
 
Do you want
Medical Coverage?
Yes
No
Uninsured & Underinsured
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:
$30/60 BI / 25 PD
$50/100 BI / 50 PD
$100/300 BI / 50 PD
$250/500 BI / 100 PD
 
Comprehensive
& Collision:
NO Coverage $250 Deductible
$500 Deductible $1000 Deductible
 
Do you want
Medical Coverage?
Yes
No
Uninsured & Underinsured
Motorists?
Yes
No
 
Send my quotation via: E-Mail Fax
Regular Mail
Call Me by Phone

 

 
Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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Recreational Vehicle Quote NOW!


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