Pre-Departure Form Step 1 of 5 - Basic Information 20% Name* First Last Email* Phone* Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Departure DetailsDate* MM slash DD slash YYYY Time* : HH MM AM PM AM/PM Vehicle Type* License or CF#* Will you require any service on your vehicle prior to leaving?*Placer RV is happy to start appliances, check tire pressure, fill your reservoirs with fresh water, dump your tanks, wash your roof, or anything else you can think of. Just let us know how we can be of service. Yes No Service SectionStart Refrigerator? Yes No Check Tire Pressure? Yes No Fill Fresh Water? Yes No Charge Batteries Yes No Upon Returning...Dump Grey/Black Tank? ($20.00 Charge) Yes No Roof Wash? ($85 Charge) Yes No Special Requests?May Incur additional charges. Δ