Save More Insurance Manufactured Home Quote
For Washington and Idaho Residents

No coverage is bound until you are contacted by one of our representatives


 PRIMARY CONTACT INFORMATION
*Name
*Address
*City, State, Zip       
 *Phone Number  Home:    Cell:
*Date of Birth
*Social Security #     
*Occupation
 Email
 Employer
 How long with current employer?
 SPOUSE INFORMATION
 Name
 Date of Birth
 Social Security #     
 Occupation
 Employer
 How long with current employer?
 HOME TO BE INSURED
 Street Address
 City, State, Zip
 How long at present address
 Previous home address if less
 than 3 years at present address
 Do you own or rent the land?
 Is mobile home in a park?   If yes, Park Name:
 Mobile Home Width & Length
 Manufacturer Name
 Model Name
 Year Built
 Serial Number
 RATING INFORMATION
 Other Occupancies:
 Age of Roof
 Roof Type   If Other:
 How will your home be used?
 How many full bathrooms in your home?
 Do you have a fireplace?
      If yes, please describe what type
 Do you have a woodstove?
      If yes, please describe type and use
 Do you have a garage?
      If yes, what type is it?
 What is your primary source of heat?
 What is your secondary source of heat?
 PROTECTIVE DEVICES & EXTRAS:
 Do you have a security system?
      If yes, please describe what type
 Do you have a burgler alarm?
      If yes, what type of Alarm?
      Alarm Company Name:
 Sprinkler System In Building?
 Smoke Detectors?
 Have you had any losses in the past 3 years?
      If yes, please describe
 Is this your first home?
      If no, do you have current insurance?
  Do you own any pets?
    If yes, Please describe 
  Any hot tubs, saunas, swimming pools, trampolines, wet bars, etc.?
    If yes, Please describe 
  Any updates that have been done on home,
      (i.e., new roof, electrical, heating, retrofitting, etc).
    If yes, Please enter date completed and describe
                                      
 IF THE HOME IS OVER 25 YEARS OLD, PLEASE ANSWER THE FOLLOWING:
 Year Electricity was Updated
 Is it on Circuit Breakers?
 Year Plumbiing was Updated
 What is the Type of Plumbing?   If Other, Describe Below:
 CURRENT INSURANCE
  Company Name
  Start date             End Date 
. How Long Insured
  Amount insured for
  Policy Number
  Premium Amount
  Policy Renewal Date
 COVERAGE INFORMATION
  Dwelling
  Contents
  Liability
  Medical Coverage
  Deductibles:  
    All Perils
    Wind/Hail/Storm
  Loss of Use
 ADDITIONAL INSURED
 Name
 Address
 Phone Number  Phone  Fax
 Account or Loan #
 LIEN HOLDER
 Name  
 Address  
 Phone #  
 Fax #  
 Loan #  
 Mortgage Clause  
 Legal description  
 Please use the space below to add comments regarding any special circumstances or coverage needs
 

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