Fillable M anufactured Home (mobile home) Quote Sheet (Risk Placement Services, Inc.)

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M anufactured Home (mobile home) Quote Sheet (Risk Placement Services, Inc.)

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The M anufactured Home (mobile home) Quote Sheet (Risk Placement Services, Inc.) form is 1 page long and contains:

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  • 26 check-boxes
  • 37 other fields

Country of origin: US
File type: PDF

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quoteMfgHome0808
M
anufactured Home (mobile home) Quote Sheet
Date:
Agency Name:
Agency Contact:
Phone Number: Fax Number:
email:
APPLICANT INFORMATION
Insured Name: DOB
OccupationAddress:
City:
State:
Zip: Prot. Class
County: Responding FD:
Miles to FD:
UNIT INFORMATION
Year: Make: Model:
Length: Width:
Purchase Date:
Purchase Price:
Occupied by: In Park with:
On permanent foundation:
Yes No
Composite roof: Yes No
In city limits:
Yes No
Swimming pool: Yes No
Gas or wood fireplace Yes No
Previously cancelled/nonrenewed:
Yes No
Land owned by insured:
Yes No
Protective Siding: Yes No
Tied down:
Yes No
Uninsured for more than 30 days: Yes No
Wood Stove: Yes No
Other supplemental heat:
3 year loss history:
(date/description/amount)
List all additions:
(size/description/value)
COVERAGE INFORMATION
Dwelling: Other structures: Personal Prop.:
Liability: Med Pay: Deductible:
Replacement cost Personal Property: Yes No Replacement cost partial loss-mobile home: Yes No
Location
Zip Code
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M anufactured Home (mobile home) Quote Sheet (Risk Placement Services, Inc.)

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Completed 30 July 2020

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