Mobile Home Quote by slesueur | Mar 24, 2020 Order Number Mobile Home Quote - Mohave Insurance Center Name (First, Last) DOB Occupancy Deeded name on property same as insured Yes No If not, who owns the MHO Year Make Model Polybutelene Pipes Yes No Fuses? Yes No Garage Attached Detached Trampoline? Animals? His occupation? His employer? Her occupation? Her employer? Date Phone (Home) Phone (Work) Miles to Fire Dept Feet to Hydrant Amount of Insurance? Purchase Price? Skirted? Hand Rails on all stairways? Any adjacent structures? Dimensions? (X by X) Woodburning Stove #of Cars Pool If so, diving board? If so, is the pool fenced in? Proof of insurance Company Any claims in the past 3 years? Details What number did you dial to reach us at?