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For a list of quote forms available, please press "Applications" tab above.

R.R.I.S. MOBILE HOME PARK QUOTE REQUEST                 


To request a no-cost, no-obligation insurance quote, just fill out the information below and press the submit button.

You may print and fax to our office if you wish.  We'll have a representative call at your convenience to give you a quote.

Ritchie and Rose Insurance Services, Inc.  DOI#0582866

PO Box 1114, Anderson, CA  96007

email: sherir@ritchieandrose.com

http://www.ritchieandrose.com

Phone: 530-365-4705  Toll Free Fax: 866-885-1428

        Please provide the following contact information:

Referral Agent

 (The Referral Agent is the name of your Insurance Agent in our office or how you became aware of our website)

First Name
Last Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
FEIN #
Work Phone
FAX
E-mail
URL

        Please provide quotes for :

General Liability       Workers Compensation    Commercial Automobile   Commercial Property   
License Bond            Performance Bond        Course of Construction  Life                  
Group Medical           

        General Liability Limit Requested (choose one):


        Please describe your operations:


        What is the name of your current insurance carrier?


        What is your current expiration date? :


        Please describe any claims you have had in the past 5 years with date of loss:


            RV Spaces  annual gross receipts / Number of RV Spaces?

Mobile Home Gross Receipts / Number of spaces?


        How many employees do you have?


        What is your estimated payroll over the next 12 months?


        How many years have you been in business?


        How many years at this location?


        Describe Recreational Facilities (playground, swimming pool, spa, pond, lake, etc.):


Do you have a convenience store here? If so, please provide:

Annual Grocery Sales
Annual Liquore Sales
 

        Use this for addional explanation area:



sheriritchie@gmail.com
Copyright 2006 [Ritchie & Rose Insurance Services, Inc.]. All rights reserved.
Revised: 06/08/2013 04:50 PM