Miller Insurance

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Our Insurance Products

Big Truck

Thank you for inquiring about insurance coverage through Miller Insurance Agency. We have been doing business for over 40 years and are experts in the insurance industry. We write policies in most States across the Nation and represent several insurance carriers including those that offer full-time RV insurance coverage. This allows us to compare the available products and offer you the best options.

Kindly fill out the interview sheet, and we will process your request.

Big Truck Quote Form

1STEP 1
Your Info

2STEP 2
Basic Property Info

Applicant Information

Please be sure to fill out the form completely, all of the information is necessary to provide you with the most accurate quote possible.

Name(Required)

Reg. Owner(Required)

Yes

No

Gender(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Driver's License #(Required)

St(Required)

Primary Phone(Required)

Cell Phone

E-mail Address(Required)

Marital Status(Required)

Level of Education

Safe driver course in the past 3 yrs?

Yes

No

Occupation

Add Another Applicant?

Yes

No

Co-Applicant Information

Please be sure to fill out the form completely, all of the information is necessary to provide you with the most accurate quote possible.

Name(Required)

Reg. Owner(Required)

Yes

No

Gender(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Driver's License #(Required)

St(Required)

Primary Phone

Cell Phone

Email Address

Marital Status(Required)

Safe driver course in the past 3 yrs?

Yes

No

Level of Education

Occupation

Basic Property Information

Please be sure to fill out the form completely, all of the information is necessary to provide you with the most accurate quote possible.

Has any Driver Completed a safe driving course?

Name

Date Completed

MM slash DD slash YYYY

Drive for lift or Uber(Required)

Yes

No

Delivery Services(Required)

Yes

No

Drive for a transportation Co?(Required)

Yes

No

USAA Member(Required)

Yes

No

Military(Required)

Yes

No

EMS (Paramedics/Firefighters etc.)(Required)

Yes

No

Any claim Activity **Anyone** Any Vehicle

Claim Record for Driver #1

Claim Record for Driver #2

ANY other Drivers in Household?(Required)

Yes

No

Relation

Do you have an active owner-occupied homeowner’s policy?(Required)

Yes

No

Carrier

What state is your home in?

Choose

Home

Condo

Renter

RV Pad

Mobile Home

Mailing Address(Required)

Is registration same as mailing?(Required)

Yes

No

Address

City

State

Zip

Garaging

Auto is garaged at this address?(Required)

Yes

No

Address

City

State

Zip

Name of Carrier on Auto?

Expiration of Auto Insurance

Why are you considering leaving your current carrier?

Carrier Limits

Number of years with this carrier?

Current Price $

Name of 2nd Mortgagee

Address

Loan #1

Loan #2

AUTOMOBILE/TRUCK #1

Loan(Required)

Yes

No

Year(Required)

Odometer

VIN#(Required)

Make(Required)

Annual Mileage

Model(Required)

ON Star?(Required)

Yes

No

Stated Value $(Required)

Series

Purchased?(Required)

New

Used

Purchased Date(Required)

Cylinder

4

6

8

10

4x4

2x2

Automatic breaking(Required)

Yes

No

Blind Spot Detection(Required)

Yes

No

Fuel(Required)

Gas

Diesel

Add another Auto/Truck?

Yes

No

AUTOMOBILE/TRUCK #2

Loan(Required)

Yes

No

Year(Required)

Odometer

VIN#(Required)

Make(Required)

Annual Mileage

Model(Required)

ON Star?(Required)

Yes

No

Stated Value $(Required)

Series

Purchased?(Required)

New

Used

Purchased Date(Required)

Cylinder

4

6

8

10

4x4

2x2

Automatic breaking(Required)

Yes

No

Blind Spot Detection(Required)

Yes

No

Fuel(Required)

Gas

Diesel

Add another Auto/Truck?

Yes

No

AUTOMOBILE/TRUCK #3

Loan(Required)

Yes

No

Year(Required)

Odometer

VIN#(Required)

Make(Required)

Annual Mileage

Model(Required)

ON Star?(Required)

Yes

No

Stated Value $(Required)

Series

Purchased?(Required)

New

Used

Purchased Date(Required)

Cylinder

4

6

8

10

4x4

2x2

Automatic breaking(Required)

Yes

No

Blind Spot Detection(Required)

Yes

No

Fuel(Required)

Gas

Diesel

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get in touch Maintaining a Personal
Relationship with Each Client.

Call us today and see how we can help you with the coverage you need.

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HOME
OUR PRODUCTS
ABOUT US
CONTACT US

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HOME
OUR PRODUCTS
ABOUT US
CONTACT US

5805 Willow Ln,
Lake Oswego, OR 97035

info@millerrvinsurance.com

503-699-9348

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Confirmation of Your Insurance Inquiry and Next Steps

Thank you for visiting Miller Insurance Agency’s web site and inquiring about insurance coverage.

We have received your information and we will be in the process of checking with our carriers for policies to
match your needs.

Once our research is completed we will contact you with our proposal.

Miller Insurance Agency Team