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Year of Home:
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Purchase Price: $
In a Park?
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If yes, how many spaces in the park ?
If home is Seasonal, is it occasionally rented to others?
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Is there any private, not-for-profit farming on premises?
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Is there a supplemental heating device?
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Does the home have Vinyl or Hardboard siding?
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Is the home skirted?
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Is the home tied down?
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Is the home on a permanent foundation?
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Does the home have a composite roof?
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Is the home vacant or unoccupied?
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Is there a swimming pool on the premises?
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Current Coverage Information
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Expiration Date (DD/MM/YYYY)
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Were there any losses or claims in the last 5 years?
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If yes, what is the date, amount paid and description of each loss or claim?
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Desired Coverage Information
Dwelling Amount - Coverage A
Other Structures - Coverage B
Personal Property - Coverage C
Loss of Use - Coverage D
Premise Liability - Coverage E
$100,000
$300,000
$500,000
$1,000,000
Policy Deductible
$100
$250
$500
$750
$1000
$2500
$5000
Golf Cart Coverage (# of Carts)
Scheduled Personal Property (Please include a copy of the schedule)
Water Back Up (American Modern only)
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Do you want contents replacement cost coverage?
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Equipment Breakdown (American Modern only)
Interested in Flood Coverage?
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About
Articles
Resources
Products & Services
Life Insurance
Life Basices
Term Life
Permanent Life Ins
Term Life Glossary
Universal Life Quote
Whole Life Quote
Second-To-Die Life Quote
Term Life Quote
Burial/Final Expense Quote
Health Insurance
Intro to Health Insurance
Implementing A Cafeteria Plan
Individual Health Quote
Employer Group Health Plan Quote
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Intro to Medicare
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Edmunds.com
Auto Ins Quote
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Travel Trailer Quote
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Boat Ins Quote
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Intro to Business Ins
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Financial Vision
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