MARKETED THROUGH
 McDole Edge Corporation
 2977 B Manchester Road • Manchester, MD 21102
Tel:(410) 902-6546 • Fax: (410) 982-0060

Motor Home Insurance Quote Request

To receive your free, personalized Motor Home insurance quote, please COMPLETE and SUBMIT the following questionnaire.

All information received is kept fully confidential and is used for quoting purposes only.

By submitting this completed form you understand there is no coverage in force until an application is approved and premium is received by the insurance company.  You certify that the statements made on this quote request are accurate to the best of your knowledge.  This Web site should not be construed as a solicitation of any sort in any jurisdictions other than those in which the agency holds a license and is authorized to transact business.  A list of licensing state(s) can be viewed at the bottom of this page.
Your Contact Information

*Your Full Name:
*Your E-mail Address:
Garaging Address:
Garaging City:
Garaging State:
Garaging Zip Code:
Day Phone:
Evening Phone:
Fax Number:
Best Way To Contact You:
 

Due to some insurance company requirements, we request that you provide your Social Security Number. It has become increasingly common for insurance companies to use general credit scores in order to qualify policyholders for certain discounts and rate structures. Therefore, supplying this number increases our ability to prepare the most accurate quote possible.

If you wish to exercise the option of not supplying this information at this time, please read and Accept the additional statement by placing a Checkmark in the box provided.

Social Security #:

... or if not providing, please accept the following statement ...

I acknowledge that by not providing this information at this time, my prepared quote may not reflect the accuracy which the agency intended to provide to me.

To review a brief explanation about how insurance companies may use your
Social Security Number and General Credit Score...

 
MAILING ADDRESS (optional)
Mailing Address
If Different from Garaging:
Mailing City:
Mailing State:
Mailing Zip Code: 
 
DRIVER INFORMATION
 
  Driver One Driver Two Driver Three Driver Four
First Name:
Birthdate:
Sex:
Marital Status:
Yrs Licensed:
State Licensed:
Occupation:

 
VEHICLE INFORMATION
 
  Vehicle 1 Vehicle 2
Year:
Make:
Model:
Vehicle Type:
I.D. #:
Cost New Value:
Miles Driven Each Year:
Ownership:

 
VIOLATION INFORMATION
 

Last 3 Yrs (Minors)
Last 5 Yrs (Majors)

 Driver 1 Driver 2 Driver 3 Driver 4

Minor Violations - Speeding,
Turn, Stop Sign, Red Light, etc.

Accidents - Non Chargeable

Accidents - Chargeable

Major Violations - Drunk Driving,
Reckless, Hit & Run, etc.

 
COVERAGE INFORMATION
 
  Bodily Injury Property Damage

Personal Liability:

Uninsured Motorist:

Medical Payment:

  

 
DEDUCTIBLE INFORMATION
 
  Vehicle 1 Vehicle 2

Comprehensive (Theft):

Collision:

 
CURRENT POLICY INFORMATION

Current Insurance Company:

Expiration Date:

Current Premium $:
How Often Do You Currently Pay:

 

Additional Comments
 Please leave any comments or additional entries here.

Click "Submit Request" to send your completed quote request.

One of our representatives will respond to you as soon as possible.
Thank you for giving us the opportunity to serve you.

Note: By submitting this completed form you understand that there is no coverage in force until an application is approved and premium is received by the insurance company.  You certify that the statements made on this quote request are accurate to the best of your knowledge.  This Web site should not be construed as a solicitation of any sort in any jurisdictions other than those in which the agency holds a license and is authorized to transact business.
 Licensed in the following states: Maryland, Pennsylvania, Virginia