Mendoza Insurance
1108 Sheridan Avenue · Chico, CA · 95926 Ph. 530-895-1086 · Fx. 530-894-6166 License #0625161
Office Hours: Mon - Fri · 9am - 5pm · (Closed Noon to 1pm)
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Get A Recreational Vehicle Insurance Quote
Your Name DOB
Email Address Marital Status
Street Address SSN
City, State, Zip ,   
Phone Number   
Expiration date of your current policy: --
Current Insurance Company:
Provide us with the following driver information:
Driver 1
Full Name
(As It Appears On License)
DOB
Driver's License #
Issuing State
 
Accidents/Violations
Please indicate any accidents or violations in the past three (3) years.
(Include month, year, city, and state of occurences, as well as whether this driver was at fault.)
Driver 2
Full Name
(As It Appears On License)
DOB
Driver's License #
Issuing State
 
Accidents/Violations
Please indicate any accidents or violations in the past three (3) years.
(Include month, year, city, and state of occurences, as well as whether this driver was at fault.)
Driver 3
Full Name
(As It Appears On License)
DOB
Driver's License #
Issuing State
 
Accidents/Violations
Please indicate any accidents or violations in the past three (3) years.
(Include month, year, city, and state of occurences, as well as whether this driver was at fault.)
 
Provide us with the following vehicle information:
Make
Model
Year
Length
Identification Number
Annual Mileage
 
Provide us with the following underwriting information:
Yes No Has the principal operator owned or driven a recreational vehicle more than 12 months?
Yes No Does the recreational vehicle have factory/dealer built-in sleeping and cooking facilities?
Yes No Does the principal operator need a Financial Responsibility Certificate?
Yes No Is the recreational vehicle used as a primary residence?
Yes No Is the recreational vehicle a converted school or public transit bus, step van, or delivery vehicle?
Yes No Is the recreational vehicle used in connection with any operator's business or profession?
Yes No Will there be any public liability exposure? If yes, please explain below.
Yes No Is the recreational vehicle used strictly for recreational purposes? If no, please explain below.
Yes No Does any operator have a significant mental or physical impairment? If yes, please explain below.
 
Please indicate desired levels of coverage:
Liability Limit
Uninsured Motorist
Medical Payments
Comprehensive
Collision
Towing
 
Additional Comments Or Questions