Homeowner Information Form — Action RV Rentals

Type of Damage

Tell us what kind of damage you have to your home. If the damage is mostly from wind and rain your Homeowner's policy should have coverage to live outside of your home during the repair process. If your damage is from rising water (flood) your policy most likely will not have coverage to live outside of the home. The exception to the rule is some Private Flood Policies do have the coverage. If your damage is flood damage contact www.disasterassistance.gov

Wind/Water from Rain

Rising Water (Flooding - Your insurance will likely not have coverage for living outside of your home.

Not Applicable/Not Insurance Claim

Do you understand we have a 2 month minimum on our rentals?

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

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Number of Adults/Children

Ages of children:

How many beds are needed?

Do you have pets that will be in the unit?

Yes

Number of Pets & Type of Pets

For Dogs please put weight/breed

Please tell us about any special needs you have - i.e. must have sturdy steps due to bad knees.

Property Claim Information

Permission Form

In order to work with your insurance carrier you must provide them permission to speak with us. We will be sending you a permission form via docusign. If for some reason you can not access the document you can contact your insurance company directly (via email or call & leave a voicemail or voice to voice contact) to let them you know that you have requested information from us and that they have permission to speak with us. If for any reason you decide not to move forward with Action RV, please contact us via email and copy your insurance company stating that you are NOT moving forward with Action RV and need to cancel all permission.

Are utilities back on at your home?

Yes Electricity

Yes Water

No Electricity

No Water

Not Applicable

Do you have a generator to run unit on if needed?

If no, we can possibly provide rental if interested.

Yes

Not Applicable

Insurance Carrier

Claim #

(If known)

Claim's Email

If you don't have this information, you can send it to us once you have it.

Claim's Phone #

If you don't have this information, you can send it to us once you have it.

(###)

###

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Loss of Use/Additional Living Expenses Amount

This will be a seperate coverage on your declarations page. It should have an amount or timeframe listed for your coverage. This helps us know your budget for the rental. If you don't have this information now, please send it once you do.

Approximately how long do you anticipate being displaced from your home based on the damages?

Referred By:

How did you hear about us?

CONTACT US