RV Rental Insurance Coverage

INSURANCE COVERAGE
YOUR INSURANCE INFORMATION
LAST NAME:
FIRST NAME:
INSURANCE CARRIER:

AllstateState FarmUSAAAmerican FamilyProgressiveGeicoFarmersAcord
OTHER CARRIER:
POLICY NUMBER:*
AGENTS NAME:
AGENT PHONE NUMBER:
Please select the trailer you have reserved.
RENTAL TRAILERS:
RENTAL TRAILERS:

17SB25SS24FS26SSR19BHSBlazen187TB (1)108ST17BH187TB (2)16KS16BB3125BH2300DB2725BH
MOTORHOMES:
MOTORHOMES:

Thor 26A28ZACE20CB23U28A26B23W30D
*You must have LIABILITY and COMPREHENSIVE and COLLISION coverage for the rented RV. If your carrier does not provide it you must select the Collision Damage Waiver. We must have WRITTEN proof of coverage for the rented RV at time of pickup.
YOUR INSURANCE COMPANY WILL NEED THE FOLLOWING INFORMATION:
** 2022 North Trail 24BHS Vin # 5SFNB2821NN513671 Estimated Value $37000
** 2018 Bounder 35K Vin # 1F66F5DY9J0A14988 Estimated Value $97000
** 2025 Cherokee 26DBHBL Vin # 4X4TCKB22SK093054 Estimated Value $37000
** 2025 Cherokee 23DBHBL Vin # 4X4TCKY24SK092964 Estimated Value $37000
** 2025 Cherokee 16BHSBL Vin # 5ZT2CKEC0SY035946 Estimated Value $37000
** 2024 24.1 Thor Vegas Vin # 1FC3E3KN5RDD47354 Estimated Value $137000
** 2023 Thor Four Winds 28Z Vin # 1FDXE4FN9PDD01472 Estimated Value $97900
** 2022 Apex 16R Vin # 5ZT2CXEC5NL014735 Estimated Value $37000
** 2022 Stealth FQ2916 Vin # 4X4TSFE20NE023741 Estimated Value $69700
** 2023 G16BH Rockwood GeoPro Vin # 5ZT2RSEC0P3030121 Estimated Value $29700
** 2023 RPod RP153 4X4TRP512PB031529 Estimated Value $27900
** 2024 Prowler 250SBH Vin # 5SFPB3028RE527552 Estimated Value $29700
** 2024 183 Roo Vin # 4X4TRLT21RZ191951 Estimated Value $35700
** 2024 Prowler 300SBH Vin # 5SFPB3524RE529226 Estimated Value $49700
** 2024 Sunseeker 2400T Vin # W1X8E33Y4NN206620 Estimated Value $139700
** 2022 Apex 208BHS Vin # 5ZT2CXKB8NL013915 Estimated Value $29700
** 2022 Apex 290BHS Vin # 5ZT2CXUB2PS044986 Estimated Value $49700
** 2023 Stealth 2750GLE Vin # 4X4TSFD26PE024686 Estimated Value $59700
** 2024 Stealth 2750SLX Vin # 4X4TSFD20RE024833 Estimated Value $59700
** 2023 Rockwood G19BH Vin # 5ZT2RSHCXP3029960 Estimated Value $35900
** 2022 Stealth 2715S Vin # 4X4TSFC21NE023864 Estimated Value $69700
** 2022 Apex 256BHS Vin # 5ZT2CXRBXNS043851 Estimated Value $47900
** 2024 Surveyor 19BHLE (7370) Vin # 4X4TSVU16RL047370 Estimated Value $39900
** 2022 Stealth 2916G (4074) Vin # 4X4TSFE23NE024074 Estimated Value $69900
** 2022 Apex 245BHS (1) Vin # 5ZT2CXPB9NL013317 Estimated Value $41900
** 2023 R-Pod RP-171 (1536) Vin # 4X4TRP713PB031536 Estimated Value $35700
** 2023 R-Pod RP-153 (1528) Vin # 4X4TRP510PB031528 Estimated Value $37300
** 2023 R-Pod RP-190 (1552) Vin # 4X4TRPU16PB031552 Estimated Value $41200
** 2023 Thor Four Winds 28A (1) Vin # 1FDXE4FN9PDD20460 Estimated Value $97990
** 2023 Thor Four Winds 28Z (1472) Vin # 1FDXE4FN9PDD01472 Estimated Value $98990
** 2023 Thor Four Winds 22E (1) Vin # 1FDWE3FN5PDD16153 Estimated Value $97990
** 2023 Thor Four Winds 31E (1) Vin # 1FDXE4FN3PDD01502 Estimated Value $119790
** 2022 North Trail 296BHS (9182) Vin # 5SFNB3224NN499182 Estimated Value $47900
** 2022 North Trail 29BHP (5030) Vin # 5SFNB3327NE495030 Estimated Value $47900
** 2022 Apex 208BHS (1) Vin # 5ZT2CXKB8NL013915 Estimated Value $41900
** 2022 Apex Remote 16G Vin#: 5ZT2CXEC6NL014730 Estimated Value $33900
** 2021 Stealth 2715G Vin # 4X4TSFC29ME023108 Estimated Value $52900
** 2022 Stealth SS1814 Vin # 4X4TSFT26NC024150 Estimated Value $47900
** 2021 Stealth 2413 Vin # 4X4TSFZ28NC023685 Estimated Value $47900
** 2022 North Trail 26BHSS Vin # 5SFNB3220NN497137 Estimated Value $49900
** 2022 Apex 185BH (2) Vin # 5ZT2CXHC9NL012661 Estimated Value $27900
** 2022 Apex 185BH (3) Vin # 5ZT2CXHC7NL014232 Estimated Value $29900
** 2023 Apex 185BH (6714) Vin # 5ZT2CXHC5RL016714 Estimated Value $29900
** 2022 North Trail 29BHP Vin # 5SFNB3327NE495030 Estimated Value $54288
** 2022 North Trail 25BHPS Vin # 5SFNB3022NN494971 Estimated Value $51330
** 2022 North Trail 24BHS Vin # 5SFNB282XNN494134 Estimated Value $49003
** 2022 Four Winds 30L Vin # 1FDXE4FN5NDC21129 Estimated Value $112,900.00
** 2022 Thor Four Winds 23L Vin# 1FDWE3FN8NDC20790 Estimated Value $107,900.00
** 2021 Stealth 2414G Vin # 4X4TSFZ28ME022913 Estimated Value $52900
** 2022 Apex 194BH (1) Vin # 5ZT2CXHCNL012780 Estimated Value $32900
** 2022 23T Thor Four Winds Vin # 1FDWE3FN1NDC13681 Estimated Value $93900
** 2022 26T Thor Four Winds Vin # 1FDWE3FN6NDC12428 Estimated Value $94900
** 2022 26B Thor Four Winds Vin # 1FDWE3FN6NDC12428 Estimated Value $94900
** 2020 177BH Palomini Vin # 4X4TPAT10LN110731 Estimated Value $23700
** 2021 185BH (1) Apex Nano Vin # 5ZT2CXHC3ML011715 Estimated Value $27900
** 2021 289TBSS Apex Vin # 5ZT2CXUB6MS041441 Estimated Value $39700
** 2021 290BHS Apex Vin # 5ZT2CXUB4MS041048 Estimated Value $37900
** 2021 15T Apex Tera Vin # 5ZT2CXDC1ML010617 Estimated Value $23700
** 2021 Four Winds 28B Vin # 1FDXE4FN9PDD01472 Estimated Value $89700
** 2021 Four Winds 30B Vin # 1FDXE4FN0MDC24633 Estimated Value $99700
** 2021 20X APEX Vin # 5ZTCXJC0ML009270 Estimated Value $25900
** 2021 194BHS APEX Vin # 5ZT2CXHC4ML010251 Estimated Value $29900
** 2021 208BHS APEX Vin # 5ZT2CXKBXML010285 Estimated Value $29900
** 2021 220EXT Apex Vin # 5ZT2CXLB4ML009244 Estimated Value $26900
** 2021 300BHS Apex Vin # 5ZT2CXVB0MS038159 Estimated Value $39700
** 2021 245BHS Apex Vin # 5ZT2CXPB7ML008826 Estimated Value $35700
** 2021 185BH Apex Vin # 5ZT2CXHC6ML008985 Estimated Value $27700
** 2021 2510BH Wilderness Vin # 5SFNB2929MN438716 Estimated Value $36700
** RL-177 Real Lite Vin # 4X4TPAT16LN110748 Estimated Value $25900
** 2020 FQ2514 Stealth Vin# 4X4TSFA22LE020827 Estimated value $39000
** 2020 CB1913 Stealth Vin# 4X4TSFU29LC020962 Estimated value $35000
** 2018 Jayco 16FD Vin# 1UJBJ0AH8J13D0132 Estimated value $25900
** 2020 185X Solaire Vin# 4X4TPAU29LN053453 Estimated value $29000
** 2020 Thor Four Winds 30D Vin# 1FDXE4FS0KDC22027 Estimated value $87000
** 2020 CB2116 Stealth Vin# 4X4TSFW28LC020769 Estimated value $39000
** 2020 Thor Four Winds 23W Vin# 1FDWE3FS1KDC25217 Estimated value $68000
** 2020 Thor Four Winds 26B Vin# 1FDWE3FS0KDC25144 Estimated value $72000
** 2020 Heartland Wilderness 3125BH Vin# 5SFNB3625LN416026 Estimated value $36000
** 2020 Heartland Wilderness 2725BH Vin# 5SFNB3325LN414555 Estimated value $32000
** 2020 Heartland Wilderness 2300DB Vin# 5SFNB2727LN414545 Estimated value $27000
** 2017 ACE 30.2 Vin# 1F65F5DY4H0A00518 Estimated value $98000
** 2018 23U Vin# 1FDXE4FS6HDC28150 Estimated value $69000
** 2019 25SS Vin# 7HN1BEH2XKP468241 Estimated value $33000
** 2019 20CB Vin# 1FDWS8PM6JKA08214 Estimated value $69000
** 2017 108ST Clipper Vin# 5ZT1CPEC7H5012554 Estimated value $10900
** 2019 26SSR Vin# 7HN1BEH28KP468240 Estimated value $33000
2016 Thor 26A Vin#: 1FDWE3FS8FDA23514 Estimated Value $76000
** 2017 Four Winds 28Z Vin#: 1FDXE4FS1GDC31701 Estimated Value $86000
2016 Travel Star 187TB (1) Vin#: 1SAB5HBJ562JB5079 Estimated Value $24000
2016 Travel Star 187TB (2) Vin#: 1SABSHBJ162JD5077 Estimated Value $24000
2017 Northland 16BB Vin#: 5UYWN211XHR023821 Estimated Value $19000
2016 Starcraft 17SB Launch Vin#: 1SABSHAJ6G2JY5091 Estimated Value $19000
2016 Eclipse Milan Vin#: 5LZBL2427GR062107 Estimated Value $21000
** 2018 19BHS Launch Vin#: 1SABS0BK8J2L95059 Estimated value $23000
2017 24FS Northland Vin#: 5UYWN2223HR023988 Estimated Value $34,000
2018 Blazen 22FS Vin#: 5UYJS2726JR024649 Estimated Value $32000
** 2018 16KS Satellite Vin#: 1SABS0AJ1J2VD5067 Estimated Value $21900
** 2018 17BH Launch Vin#: 1SABS0AK4J2LB5057 Estimated Value $21900
Additional Insured Information

RV PHOENIX, LLC
1312 N Marvin Ct STE #103
Gilbert, AZ 85233
PICKUP DATE:

MonthDayYear
Date
RETURN DATE:

MonthDayYear
Date
MY INSURANCE POLICY COVERS THE RV FOR:*

Liability OnlyBoth Laibality and Comprehensive & Collision DamagesMy insurance DOES NOT cover rented RVs
My Deductable Amount:
REMINDER: You must provide written proof that the RV is covered for full comp and collision, not just liability coverage. It must be in writing and display the RV VIN Number! We do not accept "my agent told me it is covered." It must be in writing.
I/We elect to purchase additional coverages (Class A Motorhomes):

$47 per day: CDW - Collision Damage Waiver ($3500 CDW deductible)$59 per day: CDW - Collision Damage Waiver ($2500 CDW deductible)
I/We elect to purchase additional coverages (Travel Trailers):

$39 per day: CDW - Collision Damage Waiver ($2500 CDW deductible)$49 per day: CDW - Collision Damage Waiver ($1500 CDW deductible)
I/We elect to purchase additional coverages (Motorhomes & Toy Haulers):

$47 per day: CDW - Collision Damage Waiver ($2500 CDW deductible)$59 per day: CDW - Collision Damage Waiver ($1500 CDW deductible)
The credit card on file will be billed upon completion of this form and prior to your scheduled pickup. *Pricing does not include tax & a 3.75% CC convenience fee.
CDW is NOT available for the 2019 Coachmen 20CB - An insurance endorsement is required from your insurance carrier. If your insurer does not offer the coverage you will be covered for the state required minimum coverage limits automatically.
CDW is NOT available for the 2016 Thor 26A - An insurence endorsement is required from your insurance carrier.
CDW is NOT available for the 28Z Four Winds - An insurence endorsement is required from YOUR insurance carrier.
CDW $19 per day 2015 G1 Genesis Supreme 23SS
CDW $19 per day 2015 G2 Genesis Supreme 23SS
CDW $19 per day 2015 Starcraft Launch
CDW $19 per day 2008 A3 Starcraft Travelstar
CDW $19 per day 2015 SSG Genesis Supreme 19FK
CDW $19 per day 2016 Milan Eclipse
CDW $19 per day 2014 Viking Keystone
CDW $19 per day 2005 Antigua Starcraft
CDW $19 per day 2016 B23 Genesis Supreme 23SS
CDW $19 per day 2016 RPOD Forest River
CDW $19 per day 2016 Genesis 21RSS
*You must have LIABILITY and COMPREHENSIVE and COLLISION coverage. If you do not have coverage you will be required to select the Collision Damage Waiver (CDW).
**Collision Damage Waiver (CDW) does not cover liablity insurance or incidental damages and is secondary to any other active policy. CDW is NOT insurance. (Terms and Conditions)
If you are unable to get an endorsement/rider from your agent, you will neet to purchase insurance.

To purchase insurance, visit:

www.MBAChoice.com

Enter our policy #302266 and the last six of the VIN, -
Example of ALLSTATE Endorsement:
Example of ACORD Endorsement:
Example of USAA Endorsement:
Example of STATE FARM Endorsement:
Example of AMERICAN FAMILY Endorsement:
HAVE YOUR AGENT PROVIDE YOU A COPY OF YOUR ENDORSEMENT (Bring it with you at pickup) AND HAVE THEM FAX PROOF OF RENTAL RV COVERAGE TO 480-376-0457

(The RV VIN Number must be listed on the paperwork NOT your automobile)
Signed:
Date:

MonthDayYear
Date
Should be Empty:

Example of ALLSTATE Endorsement:

Example of ACORD Endorsement:

Example of USAA Endorsement:

Example of STATE FARM Endorsement:

Example of AMERICAN FAMILY Endorsement:

HAVE YOUR AGENT PROVIDE YOU A COPY OF YOUR ENDORSEMENT (Bring it with you at pickup) AND HAVE THEM FAX PROOF OF RENTAL RV COVERAGE TO 480-376-0457