<% 'Dim strname, stremail, strtelephone, strfax, straddress, strzipcode, strbesttimetocall, strdrivername1, strdrivername2, _ 'stroperator1, stroperator2, strdateofbirth1, strdateofbirth2, strsex1, strsex2, strmaritalstatus1, _ 'strmaritalstatus2, strtrafficviolations1, strtrafficviolations2, strtrafficyes, _ 'strhomeowner, stryearmakemodel, strdescription, strgaragingzip, straudiblealarm, str, _ 'strliabilitylimits, strfirstpartybenefits, strworkloss, strfuneralexpense, straccidentaldeath, _ 'strextraordinary, struninsuredmotorist, strunderinsuredmotorist, strcomprehensivedeductible, _ 'strcollisiondeductible, stremergencyexpense, strvacationliability strname = "" stremail = "" strtelephone = "" strfax = "" straddress = "" strzipcode = "" strbesttimetocall = "" strdrivername1 = "" strdrivername2 = "" stroperator1 = "" stroperator2 = "" strdateofbirth1 = "" strdateofbirth2 = "" strsex1 = "" strsex2 = "" strmaritalstatus1 = "" strmaritalstatus2 = "" strtrafficviolations1 = "" strtrafficviolations2 = "" strtrafficyes = "" strhomeowner = "" stryearmakemodel = "" strdescription = "" strgaragingzip = "" straudiblealarm = "" str = "" strliabilitylimits = "" strfirstpartybenefits = "" strworkloss = "" strfuneralexpense = "" straccidentaldeath = "" strextraordinary = "" struninsuredmotorist = "" strunderinsuredmotorist = "" strcomprehensivedeductible = "" strcollisiondeductible = "" stremergencyexpense = "" strvacationliability = "" %>
RV Application - Auto Application - Homeowners Application
Motorcycle / ATV Application - Pleasure Boat / Personal Watercraft Application

RV Application

<% Sub RVForm %>

* Name: ">
* Email Address: ">
* Telephone: ">
Fax: ">
* Address:
* Zip Code: ">
Best time to call: ">

Driver Information
Driver Name: "> * Driver #1
"> Driver #2
Operator Number: "> * Driver #1
"> Driver #2
Date of Birth: "> * Driver #1
"> Driver #2
Sex: > Male > Female   * Driver #1
> Male > Female   Driver #2
Marital Status: * Driver #1
Driver #2
Traffic Violations: > Yes > No   * Driver #1
> Yes > No   Driver #2
If yes, please explain:
* Homeowner: > Yes > No

Vehicle Information
* Year/Make/Model: ">
* Description:
* Garaging Zip: ">
* Audible Alarm: > Yes > No
* : ">
* Liability Limits:
* First Party Benefits:
* Work Loss:
* Funeral Expense:
* Accidental Death:
* Extraordinary Medical Benefits:
* Uninsured Motorist:
* Underinsured Motorist:
* Comprehensive Deductible:
* Collision Deductible:
* Emergency Expense:
* Vacation Liability:


* - Denotes Required Field
<% End Sub %> <% If Request.ServerVariables("REQUEST_METHOD") = "POST" Then strname = Request.Form("name") stremail = Request.Form("email") strtelephone = Request.Form("telephone") strfax = Request.Form("fax") straddress = Request.Form("address") strzipcode = Request.Form("zipcode") strbesttimetocall = Request.Form("besttimetocall") strdrivername1 = Request.Form("drivername1") strdrivername2 = Request.Form("drivername2") stroperator1 = Request.Form("operatornumber1") stroperator2 = Request.Form("operatornumber2") strdateofbirth1 = Request.Form("dateofbirth1") strdateofbirth2 = Request.Form("dateofbirth2") strsex1 = Request.Form("sex1") strsex2 = Request.Form("sex2") strmaritalstatus1 = Request.Form("maritalstatus1") strmaritalstatus2 = Request.Form("maritalstatus2") strtrafficviolations1 = Request.Form("trafficviolations1") strtrafficviolations2 = Request.Form("trafficviolations2") strtrafficyes = Request.Form("trafficyes") strhomeowner = Request.Form("homeowner") stryearmakemodel = Request.Form("yearmakemodel") strdescription = Request.Form("description") strgaragingzip = Request.Form("garagingzip") straudiblealarm = Request.Form("audiblealarm") str = Request.Form("") strliabilitylimits = Request.Form("liabilitylimits") strfirstpartybenefits = Request.Form("firstpartybenefits") strworkloss = Request.Form("workloss") strfuneralexpense = Request.Form("funeralexpense") straccidentaldeath = Request.Form("accidentaldeath") strextraordinary = Request.Form("extraordinary") struninsuredmotorist = Request.Form("uninsuredmotorist") strunderinsuredmotorist = Request.Form("underinsuredmotorist") strcomprehensivedeductible = Request.Form("comprehensivedeductible") strcollisiondeductible = Request.Form("collisiondeductible") stremergencyexpense = Request.Form("emergencyexpense") strvacationliability = Request.Form("vacationliability") If (strname <> "") AND _ (stremail <> "") AND _ (strtelephone <> "") AND _ (straddress <> "") AND _ (strzipcode <> "") AND _ (strdrivername1 <> "") AND _ (stroperator1 <> "") AND _ (strdateofbirth1 <> "") AND _ (strsex1 <> "") AND _ (strmaritalstatus1 <> "") AND _ (strtrafficviolations1 <> "") AND _ (strhomeowner <> "") AND _ (stryearmakemodel <> "") AND _ (strdescription <> "") AND _ (strgaragingzip <> "") AND _ (straudiblealarm <> "") AND _ (str <> "") AND _ (strliabilitylimits <> "") AND _ (strfirstpartybenefits <> "") AND _ (strworkloss <> "") AND _ (strfuneralexpense <> "") AND _ (straccidentaldeath <> "") AND _ (strextraordinary <> "") AND _ (struninsuredmotorist <> "") AND _ (strunderinsuredmotorist <> "") AND _ (strcomprehensivedeductible <> "") AND _ (strcollisiondeductible <> "") AND _ (stremergencyexpense <> "") AND _ (strvacationliability <> "") Then %> <% Call RVForm End If Else Call RVForm End If %>