SCA Recreational Vehicle - Identification Form

1 SCA Recreational Vehicle - Identification FormClaimant NameClaimant Phone #License #Market Area (City/Zip/Postal Code)Ext. ColorVINYearMakeSeriesModelDoorsChassis Out BedroomOdometerTrans.# of Rear AxlesSlide Out Living AreaLengthEngine Size# CylindersYesNoNoAutoManualCHECKCOMPVEHIC LE EQUIPMENTSUSPENSIONMISCELLANEOUSCAB ACCESSORIESGALLEYLIVING AREAP ower Steering (PS)MicrowavePeopleMAIN AWNINGS leeps #SpringPower Windows (PW)Convection OvenElectricManualAir Ride# Fulltime BedsMor-RydePower Locks (PL)Stove# of Couches# Window AwningsSlide-Out AwningPower SeatsOvenOther# of ChairsLeather SeatsDinetteScreen RoomEXTERIOR SKINR efrigerator# of TV'sGasTrader HitchSteel# Captain ChairsCruise Control (CC)SizesElectricAluminumLuggage Rack / LadderLCDC olorBatteryRoof Storage PodFiberglassTilt Wheel (FW)Dash Air CondRem Mount Tire CarrierSUPERSTRUCTURES eparate VCRIce Box (non powered)Ice MakerSatellite DishSteel# Roof Air DVDTV/VCR ComboWater PurifierIn MotionManualAluminumSwamp CoolerHome StereoRem View Video CameraWoodDrivers Door (Class AGarbage DisposalCassFood ProcessorLEVELERS# of Solar PanelsOption)

2 Built-in BlenderAM/FM StereoCDManual Stab JacksElectric StepBuilt-in Coffee MakerCassDoubleElectric ScrewCD ChangerSingleCDCentral VacuumEqualizerHydraulic RamHEATINGC ustom WheelsCD ChangerComputer ControlledELECTRICALF urnaceSS Wheel LinersTONGUEJACKE qualizerCB - RadioI 10 VoltGasElectricAluminumChromeManualElect ric12 VoltAux HeaterWasher/DryerBATHROOMAC/DC ConverterRubber RoofHOLDING TANKSAqua HotTubShowerInvertorHydro HotSpot LightsGrey WaterSinkToiletWattsWebastoWaste WaterAir HoursPorta PottiMonitor PanelPower Roof FansFresh WaterHeat StripsHot Water HeaterGeneratorOutside Shower# LPGW aftsTV Antenna# FuelTV Antenna w/Booster# House BatteriesOTHER MECHANICAL RECEIPTSDate work done/Part(s):Desc/ $:ITIRESABOVE AVERAGEAVERAGEBELOW AVERAGESCA File # (Required)Ins. CompanyClaim Rep NameClaim Rep Phone # Loss DateClaim #Policy/Member #Insured NameInsured Phone # Loss TypeCONDITION Check either Sub-category (Seats/Paint/Engine/etc.)

3 Or Category (INT/EXT/MECH/TIRE) or write in Description and $ AVERAGEAVERAGEABOVE AVERAGEEXTERIORBELOW AVERAGEAVERAGEABOVE AVERAGEMECHANICALBELOW AVERAGEAVERAGEABOVE AVERAGEENGINENew/ RebuiltWell MaintMinor WearNeeds Minor WorkNeeds Major WorkDesc/ $:Rebuilt EngineYesNoMiles on RebuiltCost: $TRANSNew/RebuiltWell MaintMinor WearNeeds Minor WorkNeeds Major WorkDesc/ $:Rebuilt TransyesNoMiles on RebuiltCost: $SUSPENSIONNew/RebuiltWell MaintMinoir WearNeeds Minor WorkNeeds Major WorkDesc/ $:Rebuilt SuspyesNoMiles on RebuiltCost: $