• Manufactured/Mobile Homeowners Quote Request

    Manufactured/Mobile Homeowners Quote Request

  • Insured Information

  • Named Insured Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Marital Status*

  • Format: (000) 000-0000.

  • Will there be an additional named insured?*
  • Additional Named Insured Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Marital Status*

  • Format: (000) 000-0000.

  • Are you okay with us sending text messages regarding your insurance policy and/or quote? By selecting 'Yes' you grant us permission to communicate via text, while maintaining the flexibility to opt out at any time. Rest assured we will not share/sell your information.*

  • Home Information

  • Is the address you want a quote on the same as your mailing address?*

  • Due to the age of the home, the standard insurance carriers we represent will require a 4-point inspection conducted within the last year that looks at the four major systems (roof, electrical, plumbing and HVAC) of your home and assesses it for risk. You can upload a copy at the bottom of this form to the Browse Files section or email it to main@leereedins.com. Feel free to reach out if you have questions regarding this matter.

  • Is this home a park model?*

  • In order to quote your home, we will need a copy of the home's title as it is essential for us to properly assess your property. You can upload a copy at the bottom of this form to the Browse Files section or email it to main@leereedins.com.

  • If you happen to have a copy of your home's title available, sharing it with us could make the process of providing you with a quote more efficient and it would be greatly appreciated. You can upload a copy at the bottom of this form to the Browse Files section or email it to main@leereedins.com.

  • Is this a new purchase?*
  • When did you buy the home?*
  • Do you have this home currently insured?*
  • When does your coverage expire?*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Any losses in the past 5 years?*
  • Has the roof been replaced?*

  • In order to quote your home, we will need one of the following documents to confirm the age of the roof: a Final Signed off Permit, 4-Point Inspection, Roof Certification, or a Paid Receipt which cannot be handwritten. Any of these documents will suffice and can be uploaded at the bottom of this form to the Browse Files section or emailed to main@leereedins.com.

  • Type of roof covering*

  • Are you in a gated community?*
  • Is this your primary FL residence?*
  • Is this a rental property?*
  • Are you a member of AARP or AAA?*
  • Do you have any dogs?*
  • Do you have any farm animals?*

  • Attachment #1

  • Type of Attachment*

  • Attachment #2

  • Type of Attachment*

  • Attachment #3

  • Type of Attachment*

  • Attachment #4

  • Type of Attachment*

  • Attachment #5

  • Type of Attachment*

  • Have you received quotes from any other companies?*
  • Do we have permission to pull your consumer credit reports and loss history for insurance purposes? This information is required by certain insurance carriers to provide the most accurate quote possible.*
  • Browse Files
    Cancelof
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