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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.
 
Personal Information
Name 
Address
(Street, City, State, Zip)
Phone

Email
How would you like to receive your quote?
Farm Information
Field Crops ( list types )
Dairy ( # of Cows )
Equine ( # of Horses )
Boarding? ( yes/no )
Other ( specify )
Farm Premises Locations
#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
Property Deductible Desired:          
Liability Limit Desired               
# of Full Time Employees          # of Part Time Employees     
Residence #1 Additional Information
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
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
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
Description:    Limit Per Unit:  # of Units
Description:    Limit Per Unit:  # of Units
Description:    Limit Per Unit:  # of Units
Barns, Outbuildings & Stuctures
Farm #Structure:Size:Yr. BuiltLimit:
Farm #Structure:Size:Yr. BuiltLimit:
Farm #Structure:Size:Yr. BuiltLimit:
Increased Limits / Broaden Coverage (indicate total limit desired)
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     
Equine Coverages
Name of Horse
Breed of Horse
Use of Horse:
Type of Coverage
Crop Coverage
Additional Comments