Harris County Insurance

Baytown Agency
608 Rollingbrook Drive
Baytown, Texas 77521
(281) 427-6511
Pasadena Agency
825 Southmore Ave
Suite 202
Pasadena, Texas 77502
(713) 481-0700
Houston Metro Agency
4221 Telephone Road
Houston, Texas 77087
(832) 500-3666
(713) 641-1234
Houston Agency
13030 Woodforest Blvd
Suite C
Houston, Texas 77015
(832) 582-8500

Se Habla Espaol
E-Mail Us
Bookmark Us
Auto  |  Motorcycle  |  RV's  |  Boat  |  Home  |  Condos  |  Renters  |  Manufactured Homes  |  Umbrella  |  Flood  |  Mexican Insurance      




Mobile Home/Manufactured Home Insurance Quote

No coverage is bound until you are contacted by one of our representatives

 CONTACT INFORMATION
 First Name
 Last Name
 Mailing Address
 City, State, Zip
 Email Address
 Phone Number
 MOBILE HOME TO BE INSURED
 Street Address Line 1
 Street Address Line 2
 City, State, Zip
 How long at this address
 Previous home address if less
 than 3 years at present address
 City, State, Zip
 Current Insurance Company
 Insured with them for how long
 a. Do you own or rent the land
 b. Is mobile home in a park?    If yes, park name
 c. Mobile home Width & Length
 d. Manufacturer Name
 e. Model Name
 f. Year Built
 g. Serial Number
 RATING INFORMATION
 2. What type of construction was used?
 3. Number of Stories
 4. Other Occupancies:
 5. Age of Roof
 6. Roof Type   If Other
 7. Style of Home
 8. How will home be used?
 9. How many rooms?
 10. How many full bathrooms ?
 11. How many 3/4 bathrooms?
 12. How many 1/2 bathrooms?
 13. How many square feet on first floor?
 14. What type of home do you have?
 15. How many total square feet in your home?
 16. Do you have a fireplace?
      If yes, please describe what type
 17. Do you have a woodstove?
      If yes, please describe type and use
 18. Do you have a garage?
      If yes, please describe what type
 19. What is your primary source of heat?
 20. What is your secondary source of heat?
 PROTECTIVE DEVICES:
 21. Do you have a security system?
      If yes, please describe what type
      Burgler Alarm
      Type of Alarm
      Alarm Company
      Sprinkler System In Building
      Smoke Detectors
 22. Have you had any claims/losses in the past 3 years?
      If yes, please describe
 23. Is this your first home?
 24. Do you own any pets?
    If yes, Please describe
 25. Any Hot Tub, Sauna, Swimming Pool, Trampoline, wet Bar, Etc.?
    If yes, Please describe
 26. Any updates that have been done on home,
      (i.e., new roof, electrical, heating, retrofitting, etc).
    If yes, Please describe with dates completed
 IF THE MOBILE HOME IS OVER 25 YEARS OLD, PLEASE ANSWER THE FOLLOWING:
 27. Year Electricity was Updated
 28. Is it on Circuit Breakers
 29. Year Plumbiing was Updated
 30. Copper or Galvanized Plumbing   If Other
 CURRENT INSURANCE
 1. Current Insurance Carrier
 2. Start date             End Date 
 3. How Long Insured
 4. Amount insured for
 5. Policy Number
 6. Current Premium $
 7. Policy Renewal Date
 COVERAGE INFORMATION
 1. Dwelling
 2. Contents
 3. Liability
 4. Medical Coverage
 5. Deductibles
    All Perils
    Wind/Hail/Storm
 6. Loss of Use
 ADDITIONAL INSURED
 Name
 Address
 Phone Number  
 Account or Loan Number
 LIEN HOLDER
 Name  
 Address  
 Phone Number  
 Fax Number  
 Loan Number  
 Mortgage Clause  
 Legal description  

AGENCY LICENSE # 3664
Copyright @ 2007 Harris County Insurance Center - All Rights Reserved
Offices in Houston, Baytown, and Pasadena Texas.
Note: As stated in our "Terms of Service" (TOS) agreement, descriptions of insurance coverage on this web site are for informational purposes only and may not apply, or be included on your policy. Please contact us to confirm coverage provided on your insurance policy or policies your are contemplating purchasing.