SANTIAGO FINANCIAL, INC.

Manufactured Homeowners Insurance Quote

Emailed to : info@santiagofinancial.com
Your First, Last Name*
Your SS#*
Your Date of Birth*

MonthDayYear
Date
Spouse Name
Spouse SS#*
Spouse Date of Birth*

MonthDayYear
Date
Phone Number*
Email Address*
example@example.com
Park / Community Name where home is located*
Address of Home*

Street Address

Street Address Line 2

CityState

Zip Code
Primary Residence*

YesNo
Prior Address*

Street Address

Street Address Line 2

CityState

Zip Code
Year Built*
Make/Model*
Purchase Price*
Decal #
Serial #
Size of Home: Width/Length*
Patio*

YesNo
Width/Length
Carport*

YesNo
Width/Length
Fireplace*

YesNo
Dog*

YesNo
Breed
Skirting Type*

BlockBrickWoodMetal
Claims (Last Three Years)*

YesNo
If yes, list date, type and description

MonthDayYear
Date
Description of Claims
Prior Insurance Cancelled or Non-Renewed?*

YesNo
Date

MonthDayYear
Date
Reason
Personal / Premises Liability*

$100,000$250,000$500,000
Do You Currently Own a Home?*

YesNo
Purchase Date

MonthDayYear
Date
Name of current mortgage holder
Effective Date of Policy

MonthDayYear
Date
How would you like to receive this quote?
Email
example@example.com
or
Fax
161 Fashion Lane Suite 206 Tustin, CA 92780 I 714-731-8080 I 800-232-3908 I Fax 714-731-3908

California Department of Insurance License #0G26037
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Manufactured Homeowners Insurance Quote