Being Non-Renewed on your Policy for your Mobile/Manufactured Home?

Mobile/Manufactured Home Non-Renewal Form

Owner and Property Information

Name of Owner(Required)

First Last

How many Owners of Property(Required)

Name of Other Owner(Required)

First Last

Name of Other Owner(Required)

First Last

Name of Other Owner(Required)

First Last

Name of Other Owner(Required)

First Last

Name of Other Owner(Required)

First Last

Name of Other Owner(Required)

First Last

Is there a Trust?(Required)

First and Last Name of Trust(Required)

First Last

Address(Required)

Street Address City State ZIP Code

Is the Mailing Address the same as the Property Address?(Required)

Address(Required)

Street Address City State ZIP Code

Damages and Claims

ANY damage from Hurricane Ian?(Required)

Did you File a Claim?(Required)

Is the Claim Open or Closed?(Required)

Did you Experience Flood Damage?(Required)

Height of Water (In Feet or Inches)(Required)

Is all Flood Damage Repaired?(Required)

Is There Unrepaired Damage to the Property?(Required)

What Items were Damaged?(Required)

What Items are Unrepaired?(Required)

Did you Hire an Attorney for the Claim?(Required)

Did you Hire a Public Adjuster?(Required)

Upgrades or Replacements

Were any Attached Structures updated, such as Converting a screen room to Vinyl or Glass Windows? (Weather Tight Room, Enclosed Carport, or any other Custom Updates)(Required)

Please Specify the Updated Structures(Required)

Any Other Updates or Upgrades(Required)

Please Specify the Updates or Upgrades(Required)

Has your Roof ever been Replaced(Required)

What year was your roof fully REPLACED, not just repaired?(Required)

Do you have an Attached Shed? (Under Carport, etc.)(Required)

Do you have a Detached Shed (In the Back or Side Yard)(Required)

Do you have a Carport?(Required)

Do you have a Garage?(Required)

Number of Add-on Rooms(Required)

Number of Screen Rooms(Required)

Is there Polybutylene or "Gray" Pipes in any of your Plumbing Lines(Required)

Click here for a Polybutylene Example and Related Information

Has the Electric Panel ever been Replaced?(Required)

Year of Electric Panel Replacement(Required)

Rental and Other Information

Is the Home ever Occupied by Anyone other than you (Such as a Tenant or Short-Term Rental like AirBnB or VRBO)(Required)

About how many Times a year is the Property Rented to Others(Required)

Shortest Rental Period for Property(Required)

How Many Months do you Occupy the Home Each Year?(Required)

Do you have any Animals?(Required)

What kind of Animal?(Required)

Number of Dogs(Required)

Dog Breed(Required)

Do you have any Other Animals?(Required)

What kind of Animal?(Required)

Number of Cats(Required)

What Other Animal(s) (Please Specify)(Required)

Number of Cats(Required)

Do you have any Other Animals?(Required)

What kind of Animal?(Required)

Number of Dogs(Required)

Dog Breed(Required)

What Other Animal(s) (Please Specify)(Required)

Do you have any Other Animals?(Required)

What kind of Animal?(Required)

Number of Dogs(Required)

Dog Breed(Required)

Number of Cats(Required)

Mobile/Manufactured Home Non-Renewal Form

Owner and Property Information

Damages and Claims

Upgrades or Replacements

Rental and Other Information

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