Farm Quote Form | We would like to provide you with a free, no-obligation Insurance Quote. Please provide as much information as possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only. |
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Name |
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Address (Street, City, State, Zip) | |
Phone
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Email | |
How would you like to receive your quote? | |
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Field Crops ( list types ) | |
Dairy ( # of Cows ) | |
Equine ( # of Horses ) | |
Boarding? ( yes/no ) | |
Other ( specify ) | |
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#1 # of Acres # of farm residences |
Address |
#2 # of Acres # of farm residences |
Address |
#3 # of Acres # of farm residences |
Address |
Deductible & Liability Limit Options & Employees |
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Property Deductible Desired: |
Liability Limit Desired |
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# of Full Time Employees # of Part Time Employees |
Residence #1 Additional Information |
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How Long at Present Address | |
Year Built | |
Square Footage (exlcuding basement and Garage) | |
Home Type | |
Roof Type | |
Roof Age | |
Garage Type | |
Heating Type: | |
Heating Fuel Type | |
Electrical Service Type | |
Residence #2 Additional Information
Residence #2 Additional Information |
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How Long at Present Address | |
Year Built | |
Square Footage (exlcuding basement and Garage) | |
Home Type | |
Home Construction Type | |
Roof Type | |
Roof Age | |
Garage Type | |
Heating Type: | |
Heating Fuel Type | |
Electrical Service Type | |
Residence #3 Additional Information |
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How Long at Present Address | |
Year Built | |
Square Footage (exlcuding basement and Garage) | |
Home Type | |
Home Construction Type | |
Roof Type | |
Roof Age | |
Garage Type | |
Heating Type: | |
Heating Fuel Type | |
Electrical Service Type | |
Scheduled Farm Personal Property |
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Description: Limit Per Unit: # of Units |
Description: Limit Per Unit: # of Units |
Description: Limit Per Unit: # of Units |
Barns, Outbuildings & Stuctures |
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Farm #Structure:Size:Yr. BuiltLimit: |
Farm #Structure:Size:Yr. BuiltLimit: |
Farm #Structure:Size:Yr. BuiltLimit: |
Increased Limits / Broaden Coverage (indicate total limit desired) |
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Theft - Jewelry, Watches, ect. |
Theft - Goldware, Silverware |
Refrigerated Products |
Outdoor Antennas |
Livestock Confinement |
Personal Computers |
Recreational Vehicles (describe in remarks) |
Watercraft (describe in remarks) |
Farm Business Income |
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Name of Horse | |
Breed of Horse | |
Use of Horse: | |
Type of Coverage | |
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