First Name (Required) Last Name (Required)
Your email (Required)
Address Line 1 (Required)
Address Line 2
City (Required) Province (Required) Postal Code (Required)
Area Code (Required) Phone (Required) Cell
Preferred type of contact EmailPhoneCellEither Best time(s) to reach you by phone MorningAfternoonEvening
What type of recreational insurance do you need? Cottage/Vacation PropertyRV / Motorhome / TrailerAll Terrain VehicleSnowmobileWatercraftOther Other Insurance (If selected Other)
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Any claims reported in the last 5 years? YesNo
Year home built (required) Type of heat
Type of home: bungalow, 2 storey, split level, etc. (Required) Amount of contents coverage required – minimum $25,000 (Only if renter)
Date of Birth (Required)
Have you been involved in any accidents or made any claims in the last 6 years? YesNo Have you had any Highway Traffic Act convictions in the last 3 years? YesNo
Type of Recreational Vehicle 5th WheelMotor HomeCamperTent TrailerTravel TrailerToy Hauler Trailer
Does your Recreational Vehicle have a Rubber Roof? YesNo Are you the original owner of the Recreational Vehicle? YesNo
Liability Coverage Required $1 Million$2 Million$3 MillionMore than $3 Million
Year of Vehicle (Required) Make of Vehicle (Required) Model of Vehicle (Required)
Value of RV (Required) Length of RV (Required)
Type of Recreational Vehicle UtilitySports QuadSide by Side
Are you the original owner of the ATV? YesNo Liability Coverage Required $1 Million$2 Million$3 MillionMore than $3 Million
Year of ATV (Required) Make of ATV (Required) Model of ATV (Required)
Value of ATV (Required) Engine size (CCs)(Required)
Type of Recreational Vehicle Touring Trial/SportDeep Snow/MountainHybrid/Crossover Performance
Are you the original owner of the Snowmobile? YesNo Member of Ontario Federation of Snowmobile Clubs YesNo
Year of Snowmobile (Required) Make of Snowmobile (Required) Model of Snowmobile (Required)
Value of Snowmobile (Required) Engine size (CCs)(Required)
Have you been involved in any accidents or made any claims in the last 6 years? YesNo
Are you the original owner of the Snowmobile? YesNo
Coverage Required [select* liability-coverage "Liability $1 Million" "Liability $2 Million""]
Year of Watercraft (Required) Make of Watercraft (Required) Model of Watercraft (Required)
Engine Type InboardInboard/OutboardOutboard Engine Horsepower(Required)
Manufacturer List Price (Required) Market Value(Required) Trailer Value(Required)
Please describe the item(s) you want to insure
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Current Insurance Company and Policy Expiry Date
Insurance Company Policy Expiry Date
Comments
How did you hear about Newman Insurance? (Required) Existing ClientInternet SearchOnline AdFriendFlyer or BrochureLink from another siteAt a showEmail newsletterOther
By submitting this form, I agree that Newman Insurance will use this information to contact me regarding insurance.
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