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Insuring Minnesota
20960 Holyoke Ave
Lakeville, MN 55044
Phone: 952-469-0425
Fax: 952-469-1881

E-Mail us at:
info@insuring
minnesota.com

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Low Cost Minneapolis Mobile Home Insurance Rates! FREE
QUOTES!
 
 
Minneapolis Mobile Homeowners Insurance
Quotation Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data:
 
Your Name:
Property Address:
City:
State: (Must be Minnesota)
Zip/Postal:
E-Mail (REQUIRED):
Phone:
Fax (optional):
 
Owners Date of Birth & Social Security #:
(Some carriers use for additional discounts)
Current Home Lender & Loan Amount?
(Some carriers require
for replacement values)
 
Dwelling Information
 
Year Home Built:
Home Square footage:
 
Describe this Modular
or Mobile Home:
(Year, Make, Model)
 
Dimensions
(Length X Width)
 
Number of units: 1 family Duplex
 
Occupancy Type: Owner occupied
Tenant occupied
Seasonal Dwelling
Vacant or For Sale
(describe in remarks if vacant or for sale.)
 
Mobile Home Location: Inside City Limits
Inside park
Inside Subdivision
(describe Park name, or subdivision name below, if any:)
 
 
 
Type Roof: Shingle
Wood Shake
Tar/Gravel
Metal
Metal
Other
 
Is mobile home tied down? Yes No
 
Does mobile home have skirting? Yes No
 
Are there handrails on steps and decks? Yes No
 
Is there a trampoline on premises? Yes No
 
Do you own animals or pets? Yes No
 
If yes, list type/for dogs, list breed:
 
Do you have a swimming pool? Yes No
If yes, list describe fencing and diving board:
 
Other structures/outbuildings on premises? Yes No
If yes, describe outbuildings and values:
 
Fire Protection:  
 
# of feet to nearest
fire hydrant:
# of miles to nearest
fire station:
 
 
Plumbing type: Copper
Galvanized
Mixed (Copper/Galvanized)
PVC
 
Circuit Breakers or fuses? Breakers Fuses
 
Heating Type (central thermostat?):
 
Fireplace or Wood Burning Stove? (If yes, describe):
 
Any business conducted on premises?
(If yes, please describe in detail):
 
Currently Insured? Yes No
 
Current Carrier and Expiration Date?
 
Past bankruptcies or repossessions?
(If yes, describe in detail):
 
Prior Claims? Yes No
(If yes, describe claims in detail, and how problems corrected):
 
# Bedrooms: # Bathrooms:
 
Garage or Carport?: # of cars, attached/detached?
 
Special features
(i.e., deck, air conditioning, alarm systems, jacuzzi, screened porch, etc.)
 
Coverages:
 
Dwelling Cov. $ Contents $
Liability Cov. $ Deductible $
($500, $1,000, $2500):
 
Comments/Remarks
(describe any scheduled jewelry, in-home business, or other special coverages needed here):
 
Send my quotation via: E-Mail Fax
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We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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