Mobile Home Insurance Quote Form
Personal Information
Mobile Home Information
First and Last Name
Property address
Date of Birth
City, State, Zip Code
Mailing Address
County
City, State, Zip Code
Year Built
Coverage Amount
Occupation
Make (Manufacturer)
Telephone Number
With
Length
Other contact information
Name of mobile home park
Miles to Nearest Fire station
Feet to Nearest Fire
Hydrant
Who will occupy the dwelling:
 
1. Is the mobile home owned/titled in business/corporation or for any business use?
Yes
No
2. Does insured have 2 or more theft/liability losses or more than 3 losses of any kinds in the last 3 years or open/pending
claim?
Yes
No
3. Is there any un-repaired damage from previous claim?
Yes
No
4.Is the mobile home tied down and fully skirted and accessible to fire fighting equipment?
Yes
No
5. Is the mobile home currently occupied or will be within 10 days from the inception date unless it is a seasonal risk?
Yes
No
6. Is home with woodstove as primary source of heat or with a kerosene heater?
Yes
No
7. Is home located in an area prone to flooding, mudslides, brush/forest fire or within 1500 feet of any waterfront?
Yes
No
8. Is home located in an area prone to flooding, mudslides, brush/forest fire or within 1500 feet of any waterfront?
Yes
No
9. Is home on commercial farm property or with extensive farming equipments or used for food vendors, carnivals?
Yes
No
10. Is home with unattached structures exceeding 800 square feet or 50% of the value of the mobile home or being used as
living area?
Yes
No

Home Owners Policy: can  only be issued when the owner of the property occupies the house
A Fire Dwelling Policy: Will be issued to cover the building structure only (not contents) when house is occupied by other than the Home owner or
when the home owner, occupant of the home elects to do like so.
If you are a
tenant looking to cover your contents in the building you are renting you need Renters Insurance
Go to Main Page
Or Print and Fax to: 602 200-0063
24 E Broadway Rd Ste 2   Phoenix, AZ 85040  Tel: (602) 200-0062
AZ Unified Insurance Agency LLC