Recreational Vehicle Insurance

Name:
Address:
City:
Province:
Postal Code:
Phone Number:
Email Address:
Name of Principal Operator:
Date of Birth:	Date and time
Number of child(ren) who are licensed drivers:
Child #1
Name of child:
Date of Birth:	Date and time
Number of years licensed for driver:
Child #2
Name of child:
Date of Birth:	Date and time
Number of years licensed for driver:
Any at fault accidents in the past 6 years:	YesNo
If yes, # of claims & details:
Any driving convictions in the past 3 years:	YesNo
If yes, # of tickets & details:
Value of Rec. veh.:
Number of CC's:
List Price New:
Vehicle #1
Make:
Model:
Serial #:
Vehicle #2
Make:
Model:
Serial #:
Vehicle #3
Make:
Model:
Serial #:
Liability limit requested:
Coverage Preferred:
Deductible:
Can we Quote on your Home & Auto:	YesNo
If yes, when does it expire:	Date and time

Did You Know

BEGINNING OCTOBER 2018 OUR OFFICE WILL NO LONGER BE OPEN ON SATURDAY MORNINGS

We still want you to be able to contact us:

For Claims Service: Please refer to our Company specific list of after hours phone numbers to call them direct, or our Emergency phone # is 705 529 4142.

For General Inquiries: These will be handled on the following Monday (Tuesday if long weekend). Please call and leave a message in our general mailbox 705 527 6465 ext 101 or email insurance@minkinsurance.com with your inquiry.

If you are only able to come into our office on a Saturday: Please call in advance to arrange an appointment with the broker that you need to see.

Disclaimer: If you call and leave a voice mail, or email us, to make any change or request new coverage - it wil NOT be effective until confirmed by a licenced broker of Mink Insurance.

Recreational Vehicle Insurance

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Recreational Vehicle Insurance

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