Rec Application


Name:
Address:
City:	Province: Postal Code:
EMail Address:
Phone :	Day: Evenings:
Best time to Call:	am pm
Effective Date of Coverage:
Effective Date of Coverage:
PROPERTY INSURED
Type of Unit:	Category Regular Luxury Year Trade Name Model Serial # Length Loss Payee

RATING INFORMATION

Is Unit Used as a Permanent Residence?	Yes No
Is Unit Used as a Seasonal Residence?	Yes No If So Location:
Is Unit Skirted?	Yes No
Type of Heat:
Is Unit Permanently Situated in the USA?	Yes No
Actual Cash Value or Replacement Cost:

Secure, Supervised RV Park?	Yes No
Mature Citizens Discount?	Date of Birth

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