number of years at Diversified Insurance Management

RV Insurance Quote Request

From Diversified Insurance Management
Entirely Comprehensive. Completely Secure.

Welcome to Diversified!  We have tried to make our quote request page as friendly as we can, while at the same time securing essential information. Please note all items marked with an (*) are required and completing items without an asterisk may result in lower premiums. Press the tab key to jump quickly through the information fields.

 

Your application information is encrypted for your protection and security. That includes your social security number which enables us to credit score (not mandatory). If you choose to provide your social security number, credit scoring more often than not will result in lower rates.
Click the security icon to the right for further details on encryption security.

 

Please feel free to call us at 800-332-4264 for assistance in completing the quote request! Press #3 when you hear the voice, then press # 1 after the question.

 

Diversified Insurance Management is not licensed in the following states: Hawaii, New York

Diversified Insurance Management

Section 1

*First Name

*Last Name

email address

*Address

*City

*State

*Zip (00000)

*Date of Birth (MM/DD/YYYY)

Social Security Number (000-00-0000)

 

Phone Number (000) 000-0000

Cell Phone Number (000) 000-0000

Fax Number (000) 000-0000

*Occupation

*Gender

*Marital Status

*Return Quote by

*Number of years of RV driving experience

*Have you ever had your license revoked?

Have you completed a safe driving course in the last 3 years?

*Please list any moving violations, suspensions, revocations, comprehensive losses over $1000 and all accidents in the past three years

*Is RV titled to primary driver?

*If no, to whom titled?

Section 2

Please list spouse or any secondary drivers, such as family members, traveling companions, etc.

Check here and skip this section if you do not need insurance for a second driver.
Note: Your spouse's information is required if you are married.

 

*First Name

*Last Name

Email address

*Address (if different than primary driver's address)

*City

*State

*Zip (00000)

 

 

*Date of Birth (MM/DD/YYYY)

Social Security Number (000-00-0000)

*Occupation

*Gender

*Marital Status

*Number of years of RV driving experience

*Have you ever had your license revoked?

Have you completed a safe driving course in the last 3 years?

*Please list any moving violations, suspensions, revocations, comprehensive losses over $1000 and all accidents in the past three years

*Relation to the primary driver?

*Secondary driver is...
 Listed on the title
In same household as primary driver

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Section 3

Does the primary driver hold a Commercial Driver's License?

Do you own your home?

*Have you moved in the past 60 days?

*If yes, please provide previous mailing address

*How many days out of the year do you live in your RV?

Who is your current insurance carrier?

When does your current RV policy expire?
 MM/DD/YYYY

Please list RV Clubs you belong to

 

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Section 4

*RV Type

*If other, please describe type

*Year

YYYY

*New or Used

*Make

*Model

*Length

*Are you the original owner?


*Purchase Date
 MM/DD/YYYY

*Value
enter purchase price (including TT&L) if new, otherwise enter current market value

*What State is your RV registered in?

 

*What zip code is your RV registered in? (00000)

*What zip code is your RV garaged in? (00000)

Is your RV equipped with...
 Airbags
Anti theft
Anti lock brakes

Does your RV have...

Have all fiber glass sides
Have a rubber roof
Have any existing damage

Will your RV be...

*Used for business

*Stationary

*Tied down

*Permanently attached to utilities

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If you would like quotes on additional insurance from Diversified, please proceed to sections 5 and 6 before submitting.

If you DO NOT need additional quotes, please review all information you have entered and verify its accuracy. You will not be able to change your information after you click the submit button

.

Once you click “submit” you will be taken to a webpage, where you will be able to verify your information has been successfully submitted. You can also print a copy for your records.


*I understand that by submitting my information, I authorize the insurance company to access and review driving record, claim and credit reports in order to underwrite eligibility and offer the most accurate quote.

 

 

Section 5

OPTIONAL INFORMATION
Provide if you desire additional insurance quote

*Primary Driver First Name

*Primary Driver Last Name

*Primary Driver Date Of Birth

*Primary Driver Marital Status

*Secondary Driver First Name

*Secondary Driver Last Name

*Secondary Driver Date Of Birth

*Secondary Driver Marital Status

*Year (YYYY)

*Make

*Model

Body Style

Is this car...

*Used for business
Equipped with airbags
Equipped with anti theft device(s)
Equipped with anti lock brakes

*Vehicle Identification Number

*Approximate annual mileage

*Who is your current insurance carrier?

*What is the effective date of your current policy?MM/DD/YYYY

*What is the expiration date of your current policy?MM/DD/YYYY

*What are the Bodily Injury Liability limits on your current auto policy?

*Does insured/spouse have continuous vehicle liability insurance for the past 6 months with no more than a 30 day lapse

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Section 6

OPTIONAL INFORMATION
Provide if you desire additional insurance quote

 

*Year (YYYY)

*Make

*Model

Body Style

*Vehicle Identification Number

*Approximate annual mileage

Is this car...

*Used for business
Equipped with airbags
Equipped with anti theft devices
Equipped with anti lock breaks

Do you have more then 2 vehicles?

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Questions and Comments

Please provide us with any comments or questions that you might have in the space provided below. Your comments and questions are greatly appreciated.

If you do not need additional quotes, please review all information you have entered and verify it’s accuracy. You will not be able to change your information after you click the submit button

.

Once you click “submit” you will be taken to a webpage, where you will be able to verify your information has been successfully submitted. You can also print a copy for your records.


I understand that by submitting my information, I authorize the insurance company to access and review driving record, claim and credit reports in order to underwrite eligibility and offer the most accurate quote.

 

 

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