California Mobilehome Insurance Quote. Affordable Sr22's at Kostyo Insurance Agency

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Mobile Home & Motorhome Insurance Quotation Form One Simple Form - takes only 2-3 Minutes! Your Personal Data:

Your Name:
Property Address:
City:
State:	MUST be California!
Zip/Postal:
E-Mail (REQUIRED):
Phone:
Fax (optional):

1. Information for Mobile Home (If this is a motorhome skip to #2 below)

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


Type foundation:	Slab Crawlspace Pier & Post Other (list in remarks if raised, on blocks, tied (or not tied) down, on dirt, etc.)


Type Roof:	Shingle Wood Shake Tar/Gravel Spanish Tile Metal Other

Number of stories:	One 1.5 Two Three

Do you own animals or pets?	Yes No
If yes, list type/for dogs, list breed:

Are You Near Brush Area?	Yes No

# of feet to nearest fire hydrant:	# of miles to nearest fire station:

Currently Insured?	Yes No
Name of Carrier & how long insured?

Prior Claims?	Yes No
Describe claims in detail:

Plumbing type:	Copper Galvanized Mixed (Copper/Galvanized)

Circuit Breakers or fuses?	Breakers Fuses

# Bedrooms: # Bathrooms:

# Fireplaces: # Chimneys:

Special features
(i.e., deck, air conditioning, alarm systems, pool, skirting, attached parking, etc.)

Mobilehome Coverages:

Dwelling Cov. $ Contents $

Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)

2. Motorhome Coverages (if motorhome):

Year, Make & Model Value $

Length of Motorhome Comp/Coll. Deductibles $

Liability Cov. $ Driver Ages
(list violations or accidents, if any, in remarks.)

Comments/Remarks
(describe any scheduled jewelry, in-home business, or other special coverages needed here. Motorhome coverage, list driving record info.):

Send my quotation via: E-Mail Fax
Regular Mail
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You may contact our agency at the address and phone numbers below:

Kostyo Insurance Agency
4456 Vandever Avenue, Suite 10 - San Diego, CA 92120
Phone: 1-619-325-3600 / Toll-Free: 1-888-567-6985
Fax: 1-619-325-3606 / Lic# 0B55791
E-Mail us at: KIAINSURANCE@aol.com