Khalsa Insurance Agency
California License # 0F89805
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Mobile Home Insurance Quote Form...
Full Name:
Home Phone Day Time Phone
E-Mail Address:
  Home Info.
Home Usage:
Home Manufacturer:
Year Home was Manufactured:
Size of Home:
Length Width
Distance to Fire Dept:
Yes No
Tied Down:
Yes No
Do you own the Land:
Yes No
Is the Home on Wheels or on a Permanent Foundation:
Wheels Foundation
Type Siding:
  Location & Geo Info.
This home is located in City Limits:
Yes No
Land Lease Park / Size: Not in a Park
  0 - 25 Home Park
  26 - 50 Home Park
  51 - 100 Home Park
  100+ Home Park
Flood Prone Area:
Yes No
Distance to Coast:
Less than 15 Miles More than 15 Miles
  Mortgage Info.
Select One: Owned Free & Clear
  Loan on Home Only
  Loan on Land Only
  Loan on Home & Land
Current Lien Holder:
  Desired Coverage Info
Dwelling Insurance Amount $:
HOME Insurance
Do I Need Insurance?
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