C P Shipley Insurance Agency - Mobile Home Quote
Please complete this online form so that we can shop multiple companies to find you the lowest price. We usually have your quote within 48 hours! If you have any questions, please feel free to call us at 863-738-8123. Sorry, quotes are for Florida residents only.
Name
*
Mr.
Mrs.
Prefix
First Name
Middle Name
Last Name
Suffix
Date Of Birth
*
-
Month
-
Day
Year
Date
Primary Contact Number
*
Please enter a valid phone number.
Email
*
example@example.com
Prefered method of contact?
Please Select
Cell Phone
Text Message
Email
Who should we ask for?
Primary Insured
Spouse
Either One of Us
Best time to Contact You
Call Anytime
Text Anytime
Mornings
Afternoons
Evenings after 5
Evenings until 10pm
Spouse/2nd Named Insured
Mr.
Mrs.
Prefix
First Name
Middle Name
Last Name
Suffix
Date Of Birth
-
Month
-
Day
Year
Date
Address Of Mobile Home
*
Street Address
Lot #
City
State / Province
Postal / Zip Code
Occupancy Of Home
*
Owner Occupied
Renter Occupied
Tenant Occupied
Number Of Months Occupied Each Year
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Do you currently have insurance?
*
Yes, but I want to see if I can find cheaper coverage.
Yes, but I am being cancelled.
Yes, But I am being non-renewed
No, I do not currently have insurance.
No, this is a new purchase
If no insurance , How long uninsured?
Date Last policy canceled(if no lapse in insurance leave blank)
Current Insurance Provider
blanks
What date do you need this coverage to start?
*
-
Month
-
Day
Year
Date Picker Icon
Number of claims in the Last 5 years?
*
Is there a mortgage/loan on the Mobile Home?
*
No
Yes
Mobile Home Is Located:
*
Mobile Home Park (I own the lot)
Mobile Home Park (I lease the lot)
Private Property
Year Mobile Home Was Manufactured
*
Length and Width of Mobile Home (Without additions included.(Will be needed before policy can be written
Livable area square feet (If known)
SqFt
Type of roof?
*
Metal
Shingle
Membrane
Other
Year of last complete roof replacement?
*
(Type "Never" if it is the original roof)
Carport?
*
No Carport
1 Car Carport
2 Car Carport
Other
Please select all that apply to this mobile home: Will need SqFt fo0r attached structures)
*
Screen Room
Wooden Deck
Weathertight Sunroom
Added Room(s)
Attached Shed
Unattached Shed
Attached Carport or Garage
Unattached Carport or Garage
Pool
None Of The Above
Is the mobile home tied down?
*
Yes
No
Animals on premises?
*
No
Yes
If Yes, how many? Type of Animal/Breed
How Many Pets?
we also offer pet iinsurance
Any history of biting causing injury that required Medical care?
Please Select
Yes
No
Coverage
Desired Personal Liability Coverage?
*
$100,000
$300,000
Desired Coverage on the Mobile Home?
*
Examples ($10,000, $12,500, $15,000, $20,000, $25,000, $50,000, $75,000, etc.)
Contents Coverage?
*
No
Yes (Amounts Vary by carrier)
Inspections:
Have you had a 4-Point Inspection in the last 12 months?(if not most carriers require one less than 12 months old)
*
Yes
No
Do you believe your home would pass an inspection if required?
*
Yes
No
If you were referred to us, please provide name so that we can properly thank them.
Do you agree to the following terms and conditions: quotes are estimates only and are not a contract, binder or agreement to extend insurance at the quoted price. Insurance coverage cannot be bound or changed via submission of this online form/application, e-mail, voice mail or facsimile. No binder, insurance policy, change, addition, and/or deletion to insurance coverage goes into effect unless and until confirmed directly with a licensed agent. Note any proposal of insurance we may present to you will be based upon the values developed and exposures to loss disclosed to us on this online form/application and/or in communications with us. All coverages are subject to the terms, conditions and exclusions of the actual policy issued. Christopher P Shipley and Christopher P Shipley Agency is licensed in Florida only. Agency License #R029015
*
Yes, I Agree
Schedule an appointment
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