Trailer/Recreational Vehicle Insurance
Online Quote

CONTACT INFORMATION
Surname: * First Name:
Telephone:
E-mail: *
City:
Province: * Postal Code:
Employer/Association:
VEHICLE INFORMATION
RV Type Motorhome      Travel Trailer      Tent Trailer
Park Model        5th Wheel          Truck Camper
Current Value: $ Year:
Make: Model:
Body Type: Length:
Is used for daily transportation: Yes  No Is rented to others" Yes No
Has an alarm? Yes  No    
PRINCIPAL DRIVER
Age:  Years Licensed in Canada:
Claims or License
Suspension in last 6 years:
Traffic Violations or Criminal Offenses in last 3 years:
OCCASIONAL DRIVER
Age: Years Licensed in Canada:  
Claims or License
Suspension in last 6 years:
Traffic Violations or Criminal Offenses in last 3 years:
INSURANCE
Proof of insurance during the past 6 years? Yes   No
Desired Coverage: Liability
 Collision Deductible
  Comprehensive Coverage
Renewal Date: (mm-dd-yyyy)
Please tell us how you found our site: Fairlie Insurance Agency
CAUT
A search engine
Referred by a friend
Other

Instar Insurance Brokers
2435 Holly Lane, Suite 200
Ottawa, ON  K1V 7P2
Tel. 613-228-1600
Fax: 613-232-6486
Email: info@instar.on.ca