Manufactured Home Insurance Quote Request

IMPORTANT NOTICE

1. This manufactured home insurance quote request applies only to the states of Oregon and Washington. Do not fill out this form if your manufactured home is not located in Oregon or Washington.

2. No insurance will be started by submitting this form. Coverage may be placed in force only after you decide to purchase it from us, and then after you complete the insurance application and pay the initial premium.

3. Submitting the following quote request constitutes your agreement with the above statements. We will contact you within two business days after we receive your request. If you have ques

Manufactured Home Insurance Quote Request
  1. Your First Name
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  2. Middle Initial
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  3. Last Name
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  4. Date of Birth
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  5. Social Security Number
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  6. Phone Number
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  7. Email Address
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  8. Name all owners of this property
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  9. Name residents of the manufactured home
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  10. Your Street Address
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  11. City
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  12. State
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  13. Zip Code
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  14. County
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  15. Address of manufactured home, if different from above
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  16. Is home inside city limits?
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  17. Is home in park or community?
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  18. If 'Yes,' park or community name
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  19. Mailing address if different from above
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  20. Type of Woodstove
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  21. Year home was manufactured
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  22. Make and Model
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  23. Width
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  24. Length
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  25. Serial or ID Number
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  26. Is it tied down?
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  27. Purchase Date
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  28. Purchase Price
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  29. Describe any attached additions and values. Do they have heat or plumbing?
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  30. Amount of coverage wanted
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  31. Describe any claims or losses in the last 5 years
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  32. Explain reasons for any insurance cancellations or non-renewals in the last 5 years
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  33. Is the home raised more than 4 feet on any side?
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  34. Describe any farm or ranch activity on the premises
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  35. Describe any pets or animals kept on the premises
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  36. Have your animals bitten or injured anyone in the last 5 years?
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  37. Describe any business activity on the premises, including daycare
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  38. If home is vacant, explain why
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  39. Is the home fully installed and connected to utilities?
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  40. Describe any other structures on the premises
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  41. Describe any swimming pool or area on the premises deeper than 2 feet on the premises
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  42. Additional information or comments
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  43. Re-type the security field numbers in the box.
  44. Security Field
    Security Field The Security code you typed did not match. Please click "Refresh" and try again.
  45. To keep a copy of this form, please Print before Submitting
  46.   

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Questions?

If you have questions concerning this information, please call us at 503-620-0230, or come in.

Llámenos ya al 503-620-0230.