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
Format: (000) 000-0000.
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
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
Width/Length
Carport
Width/Length
Fireplace
Dog
Breed
Skirting Type
Claims (Last Three Years)
If yes, list date, type and description

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

MonthDayYear
Date
Reason
Personal / Premises Liability
Do You Currently Own a Home?
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
Should be Empty:

Manufactured Homeowners Insurance Quote