Name
E-mail
Tel
Fax
Mailing Address
City
State
Zip Code
Street or Farm Address
City
State
Zip Code
County
Acres of Farm?
Name of Farm
Number Horses owned by you
Number of owned horses used for lessons.
Presently Insured
NO
YES
Company
Amt Coverage Requested
$100,000
$300,000
$500,000
$1,000,000
Compare All three
Different Amount
Type of Coverage Requested
Liability
Commercial Equine Liability
Private Horse or Show Owner Liability
Receipts for Boarding
What Type of Lessons
Receipts for Lessons
Receipts for Training
Number boarded horses
Number Horses in Training
Discipline/s Taught
Brief Description of Operations
Do you want Care Custody & Control Coverage?
Yes
No
Coverage Amount for Care Custody and Control
$5,000
$10,000
Higher Limit
If you only desire Liability Coverage then skip section 2 if you desire Farm Coverage please fill out section 2 below.
Section 2
Farm Insurance Section ( Please make sure you filled out the section above in addition to this section.
Social Security # (Required) or FEIN#
If you would rather not give out this information please call our office at
352-347-8478 or Toll Free 1-888-533-8304
Social Security# or FEIN#
Street or Farm Address
City
State
Zip Code
County
Acres of Farm?
Farm Insurance Include Liability Information
Dwelling
Dwelling Construction
Frame
Masonry
Metal
Other Specify
Square Footage of Dwelling
Replacement Value
Roof Type
Yes
No
Barn 1
Barn Construction
Frame
Masonry
Metal
Other
Number of Stalls
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20+
Sq Footage Barn 1
Replacement Value
Barn 2
Barn Construction
Frame
Masonry
Metal
Other
Number of Stalls
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20+
Sq Footage Barn 2
Arena
Other Building
Other Building
Deductible Amount
Distance to Fire Station
Do You have Fire Safety Equipment Installed e.g.
Sprinkler's, Fire Extingusher's?
Yes, Sprinkler System and Fire Extingushers
Yes, Fire Extingusher's Only
Alarm System on Dwelling
No, No Additional Safety Equipment
Smoke Detectors
Dead Bolts
Central Station
