Vienneau Assurance Ltd.

For New Brunswick residents only.

Name:

Email Address:

Age:

Address:

City:

Postal Code:

Phone Number:

Year of trailer:

Make and Model:

Length:

Is trailer parked year round at a trailer site:

Yes

If yes, please provide the name of the Trailer Park :

Amount of insurance required on Trailer:

Amount of insurance required on Contents:

Any claims in the last 6 years?

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