Name:
Address:
Work Telephone:
Province:
Ontario
City
:
Postal Code:
Telephone:
Best time to be contacted:
Monday
Tuesday
Wednesday
Thursday
Friday
9am-12pm
12pm-4pm
4pm-7pm
Year purchased new:
Year manufactured:
Name of manufacturer:
Model:
Length (ft.):
Is trailer permanently located:
yes
no
Are you over 55:
What coverages do you require on the vacation trailer:
Have you had any previous losses or cancellations:
yes
no
Deductible required:
$100
$200
$500
none
It is warranted that the trailer or camper unit will be used solely for private recreation and vacation purposes and will not be used otherwise!
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