Towed Trailer Application - Wayfarer Insurance Group

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Towed Trailer Application

Please complete this form in its entirety to bind coverage. The insured’s signature is required to bind a policy.
Please note: as a subbroker you have no binding authority. Coverage will be bound once the application is received and approved by one of our brokers.

Additional Applicant Details

Is there an additional applicant to be added to the policy? (please insure both names show on the ownership)

YesNo

First Name

Last Name

Date of Birth

Is the trailer located at a premises other than the insured’s home address?

YesNo

If yes:

Park/Storage Facility Name

Street Address

City

Postal Code

Risk Details

Serial Number

Is the applicant the registered owner of the trailer?

YesNo

Is the Trailer registered in the name of a company, corporation, estate or held in trust?

YesNo

Has the applicant been refused insurance or been cancelled or lapsed by an insurer?

YesNo

Is the Trailer owned and/or occupied by three or more unrelated individuals?

YesNo

Is the Trailer used strictly for recreational purposes?

YesNo

Is the Trailer rented or leased to others?

YesNo

Does the Trailer have any heating that was not factory installed?

YesNo

Are there any extensions and/or modifications to the Trailer other than factory installed?

YesNo

Is the trailer garaged, parked, situated or stored outside of the Insured’s province of residence?

YesNo

When not in use, is the trailer situated on a premises not owned or rented by the insured?

YesNo

Is the Trailer rebuilt or refurbished unit?

YesNo

Is the trailer registered and plated in the insureds province of residence?

YesNo

Is there any existing or unrepaired damage on the trailer?

YesNo

Is there more than 1 lienholder?

YesNo

Is there a lienholder/Interested Party?

YesNo

Bank Name and Address

Additional Information

How many years immediately preceding this policy has the applicant had continuous trailer insurance?

Has the applicant had any claims on their recreational trailer in the immediately preceding 5 years?

YesNo

If yes, list claim details

Is the trailer used or occupied as a residence?

YesNo

If yes, provide details

Payment type

Direct BillPre Authorized Payments (require void cheque and signed authorization form)

Requested effective date

Signature of Insured

Date (YYYY/MM/DD)

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Wayfarer Insurance Group Incentive Campaign Terms & Conditions

Be eligible to receive a complimentary $10 e-gift card (“gift card”), via Tango Blast Rewards operated by Tango Card, Inc. (“Tango”) as a thank you for requesting a free, no-obligation RV insurance quote by calling Wayfarer Insurance Group at 1-844-929-4768 between 9:00 a.m. and 5:00 p.m. ET, Monday to Friday and between 9:00 a.m. and 1:00 p.m. ET, Saturday, not including Statutory holidays or any holidays recognized by Wayfarer Insurance Group (“Wayfarer”), before this offer expires on December 31, 2022. Persons requesting a quote (the “requester”) must complete the required information and review the quote with a Wayfarer Insurance broker on the telephone to be eligible to receive the gift card as a thank you. Anyone entering this promotional offer cannot request multiple quotes for the same insurance product throughout the term of this offer. Anyone obtaining quotes directly from any insurer associated with Wayfarer Insurance will not be eligible for a complimentary gift card. No purchase necessary.

After the quote process has been successfully completed, (as described below) Wayfarer will advise Tango to send the requester a “Tango Card Reward Link” email via a secure FTP site. Requesters who successfully complete the quoting process, and who are eligible for a gift card will receive an email from Tango with their “Tango Card” valued at $10 Canadian (email includes redemption instructions). To complete the reward process, requesters will click on the redemption URL link in the email, to take them to the Reward Link website to select the gift card(s) they would like to receive.

Gift cards will be delivered electronically to the eligible requester by email from Tango. Members must provide a valid email address to receive their gift card. Gift cards will only be delivered electronically and not by any other means of delivery. Please allow ten (10) business days for delivery of the gift card(s) save and except for any unforeseen events such as, but not limited to, a weather event, postal or courier strike, flood, fire, war, break out of disease, quarantine, hydro outage, service provider problems. Gift cards can only be used in Canada.

A maximum of one $10 award per household per email address will be provided if eligibility requirements are met. Requester must be at least 18 years of age and a resident of Canada. This offer is not available to Wayfarer Insurance Group’s affiliated companies, Leisure Days or Wayfarer Insurance Group employees and members of their respective immediate families and/or anyone with whom the employees, directors and trustees are domiciled.

The gift cards are non-transferable and non-exchangeable for cash. Any and all taxes on the gift card, including income taxes, and any incidental expenses associated with collection of the gift card are the responsibility of the recipient. No substitutions will be made for the gift card except at the discretion of Wayfarer who may substitute a thank you gift of equal or greater value in the event the current thank you gift is no longer available to Wayfarer Insurance Group. Wayfarer reserves the right to withdraw, terminate, suspend, cancel or modify all or part of the thank you offer, including the number of gift cards awarded, at any time and without notice if it determines that for any reason the offer cannot be run as originally planned, including, but not limited to, technical failure or corruption, computer virus, tampering, unauthorized intervention, fraud or any other cause beyond Wayfarer’s control which in Wayfarer’s opinion compromises the fairness or integrity of the offer and/or affects the administration, security, or proper conduct of this offer. Failure to comply with Wayfarer’s terms and conditions may disqualify the requester from receiving the complimentary gift card. Wayfarer is not responsible for any referral and/or quote that is lost, late, damaged, destroyed, corrupted or misdirected, incomplete, garbled, or delayed by or on any computer, online telephone or technical malfunctions that may occur in the processing transmission or receipt of the referral and/or quote.

Wayfarer is not responsible for any theft, destruction or unauthorized access to, or alteration of, requests for quotes; failures or malfunctions of electronic data transmission, telephones, telephone lines or telephone systems, interrupted or unavailable network, server or other connections, any error, omission, interruption, defect or delay in any transmission or communication; traffic congestion on the Internet or for any technical problem, including but not limited to any injury or damage to any person’s computer related to or resulting from contacting Wayfarer; the cancellation, suspension or preemption of games, injuries or timing errors, electronic or equipment failure or other communication problems occurring in connection with participation in this thank you offer nor is it responsible for any transmission of viruses from the Wayfarer Web site to a computer system or if any whole entry system crashes resulting in the thank you offer being cancelled or other problems or errors of any kind whether mechanical, human, electronic or otherwise.

Wayfarer, and any of their parents, affiliates, agents, and contractors, including advertising and promotional agencies, and their directors, trustees, officers and employees expressly disclaim and shall be held free of all responsibility or liability for any act, error, omission, injury, loss, accident, delay or the neglect or default of any company or person providing any service for the thank you offer and/or providing quotes, whether through providers negligence or otherwise, or due to epidemic, social or political disturbances or due to any cause whatsoever occurring during the offer and the use of the thank you gift.

By taking part in this thank you offer, the requester releases and forever discharges Wayfarer and any of their parents, affiliates, agents, and contractors, including advertising and promotional agencies, and their directors, trustees, officers and employees from any and all actions, proceedings, suits, liabilities, claims, damages, costs, expenses and demands which he or she may at any time hereafter have against Wayfarer and any of their parents, affiliates, agents, and contractors, including advertising and promotional agencies, and their directors, trustees, officers and employees in respect of anything done by it in the performance of its duties hereunder. The requester further agrees to indemnify and save harmless Wayfarer and any of their parents, affiliates, agents, and contractors, including advertising and promotional agencies, and their directors, trustees, officers, and employees from any and all actions, proceedings, suits, liabilities, claims, damages, costs, expenses and demands brought, commenced or had against them in respect of anything done by it in the performance of its duties hereunder. The provisions of this section shall survive the termination of this thank you offer and may be relied upon by the parties hereto at any time.

All decisions by Wayfarer are final. Please contact Wayfarer’s marketing and communications department at 1-844-929-4768 with any questions or comments regarding the terms of this thank you offer.

If the requester requests marketing information about Wayfarer and/or Wayfarer products and services, Wayfarer may send the marketing information to the requester’s email address, residential address or as otherwise directed by the requester. Personal information will not be shared with parties outside of this promotion but will be used by Tango to deliver the gift card of choice by way of a secured website to the qualified requester. If anyone wishes to receive marketing materials from Wayfarer or if anyone does not wish to receive marketing materials after consenting to do so can contact a Wayfarer representative at 1-844-929-4768 or by email at [email protected]. Note: all telephone calls are recorded for quality assurance.

The merchants represented are not sponsors of the rewards, partner or sponsor in this offer or otherwise affiliated with Wayfarer Insurance Group or Tango Card, Inc. The logos and other identifying marks attached are trademarks of and owned by each represented company and/or its affiliates. Please visit each company’s website for additional terms and conditions.

Caution: Any attempt by a person or any other party to deliberately damage any Web site or undermine the legitimate operation of this offer is a violation of criminal and civil laws. Should such an attempt be made, Wayfarer reserves the right to seek damages from any such person to the fullest extent permitted by law. Sponsor: Wayfarer Insurance Group 308 Bay St, Box 160, Beaverton, ON L0K 1A0. The Wayfarer logo is a registered trademark used on consent. All other trademarks, service marks, images and logos are property of their respective owners and are displayed in this publication with permission. All Rights Reserved.

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