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Indicates required field
Address
*
Park Name
*
County
*
Model Year
*
Serial #
*
Width
*
Coverage Amount Dollar amount the home is being insured for. In most states, Manufactured Homes can be insured for either Replacement Cost (RC) or Actual Cash Value (ACV). Please check your state specific program guide for further details. Single-wide homes must be insured for a minimum value of $25,000 to qualify for RC coverage. Double-wide homes must be insured for a minimum value of $50,000 to qualify for RC Coverage.
Length
*
Length This is the length of the mobile home (in feet), rounded up to the nearest foot. You can enter up to 2 digits.
Wood Stove Or Fireplace
*
-
Commercially Installed
Factory Installed
Self Installed
None
Is the Mobile Home tied down or anchored?
*
-
Yes
No
Coverage Amount
*
Name
*
First
Last
Date of Birth (MM/DD/YYYY)
*
Occupation
*
Email
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