Is your current insurance protection specifically tailored to your RV lifestyle? Does your insurance company or agent understand your RV insurance needs? Are you paying too much for too little?

Relax and enjoy life. As a true “RV Specialist”, our objective is to determine your individual RV Insurance needs and offer economical protection to meet them. To obtain a free, no-obligation quote for your recreational vehicles, simply complete theĀ online application below or call us at 1-800-456-5305. Please note that the results of this form will be sent via email. In the unlikely event that you encounter problems, please print your form and fax it to 1-800-847-3129.

POLICY HOLDER INFO *Required Field
First Name: *
Middle Name:
Last Name: *
Mailing Address: *
City: *
State:

*

Zip: *
Registration Address: *
Email Address: *
Current Insurance Policy
Policy Expiration Date (mm/dd/yyyy)
PRIMARY DRIVER INFO
Name:
Date of Birth:
Gender: Male
Female
Marital Status Single
Married
Widowed
Drivers License #:
Licensed in State:
RV Info
Year:
Make:
Model:
Purchased Price (not including trade in): New
Old
Length: ft
Annual Miles:
Is your RV ever used in ANY business situation? Yes
No
Is your RV ever rented or loaned to others? Yes
No
If so, which? Rented
Loaned
Is your RV owned by persons residing in separate households? Yes
No
COVERAGE INFO
Please indicate the coverages and limits that you want:
BI/PD Liability:
UM/UIM Liability:
Medical Payments:
PIP:
Comprehensive Deductible:
Collision Deductible:
Diminishing Deductible? Yes
No
Towing and Labor or Roadside? Yes
No
Total Loss Replacement? Yes
No
Vacation Liability: (less than 5 months)
Full-Timers: (over 5 months)
DISCOUNT INFO
Please check all that apply. Audible Anti-Theft Alarm
Member of an RV Association
Member of an RV Manufacturer’s Club
Anti-Lock Brakes
Garaged
CDL or Defensive Driving Course
Expiration date of CDL or Course
IMPORTANT: This information is requested for the sole purpose of creating your insurance profile. From this profile, we will generate insurance quotes by using the rating methods. When you submit this form, the information will be transmitted via email to our customer service department. If you are not comfortable in sending this information through email and the Internet, we suggest that you print the completed form and fax it to us at 1-800-847-3129. DISCLAIMER: By submitting this application to The Campbell Group, I hereby declare that the above statements are true. No coverage will be issued or bound until I receive confirmation from a licensed representative of The Campbell Group. I understand that this is a request for a quotation only and that I am under no obligation.