 MOBILEHOME
QUOTE FORM |
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MOBILEHOME
QUOTE FORM |
| Contact Information | |
| First Name: | |
| Last Name: | |
| Phone Number: | |
| Fax Number: | |
| E-Mail Address: | |
| Age of Oldest Owner: | |
Property Information |
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| Property Address: | |
| Property City: | |
| Property State: | CA |
| Property Zip Code: | |
| Purpose Of Use: | |
| Mobilehome Park Name (If On Private Property Please Indicate): | |
| Number Of Spaces In The Park: | |
| Year Built: | |
| Mobilehome Manufacturer Name: | |
| Any Loans on Property | yes no |
| Is The Mobilehome Tied Down? | yes no |
| Is The Mobilehome Fully Skirted? | yes no |
| Located Within City Limits? | yes no |
| Does The Mobilehome Park Have A Full-Time Resident Manager? | yes no |
| Ever Been Refused Insurance In The Last 3 Years? | yesno |
| Located In A Flood Zone? | yesno |
| Length and Width Of Mobilehome (eg: 24 x 60): | |
| Smoke Alarm: | yesno |
| Fire Extinguisher: | yesno |
| Deadbolts: | yesno |
| Does The Mobilehome Have A Fireplace or Woodstove? | yesno |
| Burglar Alarm: | |
| Current Insurance Company: | |
| Any Dogs on the Property: | yesno |
| If Yes, Number & the Breed of Each Dog: | |
| Losses-Claims in the last 3 years: | |
| If Yes, Date, Amount Paid & Description of Each Loss-Claim | |
COVERAGE INFORMATION |
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| Dwelling Amount (Coverage A): | |
| Other Structures (Coverage B): | |
| Personal Property (Coverage C): | |
| Loss of Use (Coverage D): | |
| Premise Liability (Coverage E): | |
| Policy Deductible: | |
| Dwelling Replacement Cost Coverage: | yesno |
| Contents Replacement Cost Coverage: | yesno |
| Questions or Comments
or additional coverages you may need: |
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