Mobile Home Quote Sheet
 
Instructions: Please fill in the following information and a Qualified Johnston Meier Insurance Representative will contact you with your quote. 

Note: Quoted prices are only valid within the Province of British Columbia, Canada.

1.
Risk location, if different from postal address?
2.Year Built
3.Trade Name
4.Model
5.Size
6.Serial Number
7.Deductible required 
8.Age Discount Applies?
If yes, date of birth 
9.Occupancy
10.Fire Protection
11.Heat
12.Type of Coverage required
13.Have you had any losses in the
last 3 years?
Yes No
     If so, give details & claims amount
     paid by the insurance company:


Contact Information
Name
Address
City
Postal Code
Email Address
Telephone #
Fax #