insurance graphic

You may just want to change agents - Check with us before you buy or renew!

insurance graphic

Low Cost
Insurance for
North Carolina
Residents!


Call Us for a
RUSH Quote.
We can place
Coverage
INSTANTLY!

 
Or, Get A FREE
Quote On-Line

 
 
Auto Insurance
"D.W.I." Insurance
Antique & Classic Car
Cycle & 4 Wheeler
Homeowners
Builder's Risk
Modular/MobileHome
Businessowners
Worker's Comp
Commercial Auto
Contractor Liability
Recreational Vehicle
Boat Insurance
Life Insurance
Short Term Health
Hospital Insurance
Medicare Supplements
Disability Insurance

 
Contact Us
 
 
E-Mail:
apbenfield@aol.com

Phone:
Toll Free:
1-866-632-6458
Direct Line:
1-828-632-6505

Fax:
1-828-632-0172

Mailing Address:
78 East Main
Avenue
Taylorsville,
NC 28681

Insurance
License #:

237-68-0393

Meet Our Staff!


For Your
Convenience,
We Accept:

Don't forget to ask about our "10+10" Insurance Discount! That's 10% off your Home and Auto Insurance when we write both policies. DOUBLE Your Discounts NOW!

insurance
 
 
Mobilehomeowners Insurance
Quotation Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data:
 
Your Name:
Property Address:
City:
State: (Must be North Carolina)
Zip/Postal:
E-Mail (REQUIRED):
Phone:
Fax (optional):
 
Owners Date of Birth?
(Some carriers use birthdates for additional discounts)
Current Home Lender & Loan Amount?
(Some carriers require
for replacement values)
 
Dwelling Information
 
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
 
Occupancy Type: Owner occupied
Tenant occupied
Seasonal Dwelling
Vacant or For Sale
(describe in remarks if vacant or for sale.)
 
Mobilehome Location: Inside City Limits
Inside park
Inside Subdivision
(describe Park name, or subdivision name below, if any:)
 
 
 
Type Roof: Shingle Wood Shake
Tar/Gravel Metal
Metal Other
 
Is mobilehome tied down? Yes No
 
Does mobile home have skirting? Yes No
 
Are there handrails on steps and decks? Yes No
 
Is there a trampoline on premises? Yes No
 
Do you own animals or pets? Yes No
 
If yes, list type/for dogs, list breed:
 
Do you have a swimming pool? Yes No
If yes, list descibe fencing and diving board:
 
Other structures/outbuildings on premesis? Yes No
If yes, describe outbuildings and values:
 
Fire Protection:  
 
# of feet to nearest
fire hydrant:
# of miles to nearest
fire station:
 
 
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)
PVC
 
Circuit Breakers or fuses? Breakers Fuses
 
Heating Type (central thermostat?):
 
Fireplace or Woodburning Stove? (If yes, describe):
 
Any business conducted on premises?
(SIf yes, please describe in detail):
 
Currently Insured? Yes No
 
Current Carrier and Expiration Date?
 
Past bankruptcies or reposessions?
(If yes, describe in detail):
 
Prior Claims? Yes No
(If yes, describe claims in detail, and how problems corrected):

# Bedrooms: # Bathrooms:
 
Garage or Carport?: # of cars, attached/detached?
 
Special features
(i.e., deck, air conditioning, alarm systems, jacuzzi, screened porch, etc.)
 
Coverages:
 
Dwelling Cov. $ Contents $
Liability Cov. $ Deductible $
($500, $1,000, $2500):
 
Comments/Remarks
(describe any scheduled jewelry, in-home business, or other special coverages needed here):
 
Send my quotation via: E-Mail Fax
Regular Mail
Call Me By Phone

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a Quote NOW!


Help Us Fight Spam! Type the Numerical Code you see at right, into the empty text box on the left, so we know you are a human. Thanks for your help!

Enter code at right, here:
Web Form Protection Code
reload image

Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!

 
Terms of Use/Privacy Notice/Copyright Info. No. Carolina Insurance Online since: September 2,000.
Please report site-related technical problems to: apbenfield@aol.com    2008 Insurance-Web-Sales
 
insurance graphic