Quote Request

	By filling out this form you are applying for pricing and availability of insurance for your Motorhome, 5th wheeler or towed caravan. If you wish to apply for a policy please click here to go to our downloads section and fill out the appropriate forms >>
Registered Owners Name *
Email Address *
Phone Number
Area
Details of the motor home / camper to be insured:
Vehicle Type
Year
Make & Model
Purchase Price
Have you, or any of your intended drivers, had any vehicle accidents in the last 5 years?	Excluding glass
Age of Main Driver?
Current annual mileage
Are you a member of the NZMCA?	yes no
NZMCA membership number
Do you wish to exclude under 25 year old drivers	yes no
Amount of Cover Required?
Is the vehicle on a	WOF COF
Are you currently eligible for a Full No claims bonus discount with any vehicles fully insured elsewhere?	yes no
Does the vehicle have a built in sink bench and bed?	yes no
Enquiry	I am interested in a quote on insurance for my motor home. based on the above information.