Stan Taylor Insurance Agency

Mobile Home Insurance

Let us quote your mobile home insurance! Please fill in this form and submit it to us. We will contact you by the end of the next business day with a quote.

We currently write in NC and SC.

General Information
*Name		Date of Birth
Address		Social Security Number
Address		*City
*State		*Zip Code
*Prefer Contact By: Phone Email Fax
*Work Phone		*Email Address
*Home Phone		*Best Time to Call
*Fax

Where is the home located (if different from above)?

Address

City

County

State

Zip Code

(Please check one)

1. Primary residence (at least five consecutive months)
2. Seasonal residence (less than five consecutive months)
3. Rented to someone else

Description of Home

Year:

Make:

Serial Number (if known):

Length:

Width:

Purchase Price:

Current Value:

Amount of Insurance desired on home:

Is there a supplemental heating device in the home?

Yes No

Is the home located in a:

1. Mobile Home Park

2. Private Property

Has the applicant had any similar insurance declined, cancelled, or non-renewed?

Yes No

Has the insured had any losses to property in the last 3 years?

Yes No

Does the applicant own any dogs?

Yes No

How did you find out about Stan Taylor Insurance?
Questions or Comments?

I hereby declare to the best of my knowledge and belief that all of the above statements are true and that these statements are offered as an inducement to the company to issue the policy for which I am applying. Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may be guilty of insurance fraud.

I understand that I am supplying this information to obtain a quote and that no coverage will be bound unless specifically sent to me in writing.

Disclaimer

Directions & Hours

Contact Information -
3826 Bland Road
Raleigh, North Carolina 27609
Telephone : 919-781-5300
Fax : 919-787-1896
Electronic Mail : webmaster@stantaylor.com