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Mobile Homeowners Quote Request
 
To receive a free quote from Bedford Grange Mutual, please answer the following questions.
 
 
Name of Mobile Home Owner
 
Mailing Address
 
Home Phone #
 
Work Phone #
 
Fax #
     
 
Property Address
     
 
Current Insurance Carrier
 
Policy Expiration Date
 
Any Paid or Pending Claims
in last 5 years:
Yes
No
 
(If yes: Amount paid)
 
(If yes: Date paid)
     
 
Year of Home
 
Make and Model of Home
 
Dimensions of Home
 
 
Full basement foundation:
Yes
No
 
Tied Down:
Yes
No
 
Skirted:
Yes
No
 
Type of Heating System
 
Location of Oil Tank
 
Condition of Oil Tank
 
Type of Cooling System:
 
Fireplace:
Yes
No
(If yes, Wood or Gas)
Wood
Gas
 
Any other supplemental heat:
Yes
No
 
 
Roofing Material:
Asphalt Shingles:
 
Metal:
 
Other:
 
 
Siding Material:
Vinyl:
 
Aluminum:
 
Wood:
 
Other:
 
 
Do you own or rent the lot where your home is located?
Own:
Rent:
  If you own, number of acres?
 
 
     
 
Any dogs owned or kept at home?
Yes
No
 
Any other animals owned or kept at home? (horses, cows, exotics or others)
Yes
No
         
 
Coverage amount for home:
 
 
Liability amount requested:
$100,000
   
$300,000
   
 
Medical Payment to Others:
$1,000
   
$2,000
   
 
Policy Deductible:
$500
   
$1,000
   
         
 
In-ground or Above-ground Swimming Pool on Premises?
Yes
No
 
     
 
Are there working Smoke Detectors?
Yes
No
         
 
Are there Fire Extinguishers?
Yes
No
         
 
Are there any Smokers in dwelling?
Yes
No
         
 
Do all adults work away from home?
Yes
No
         
 

This home is occupied full time by the person listed on the Title and/or Deed.

Receiving a quote is not considered a binder for insurance. To bind coverage you must complete and sign all applications and pay a deposit premium. If coverage is bound, it is subject to all company terms, conditions and guidelines which could change the premium or the coverage quoted or even cause the application to be refused or cancelled. By filling out this form, you agree to these terms. We will respond to you via email. Thank you.

         
 
Your email address:
         
 
       
 
 
Bedford Grange Mutual underwrites Property and Casualty Insurance for properties located in the state of Pennsylvania.
     
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477 West Pitt Street P.O. Box 31
Bedford, PA 15522
Phone: (814)623-8515 or
(800) 707-2246
Fax: (814) 623-6991
Monday - Friday 8:00 - 4:30