Farm Owners / Stable Liability Questionnaire

To receive a quote, please complete & submit the questionnaire below.

If you have any questions while filling out the form, give us a call at 1(800) 321-5723. We’re happy to help.

Fields marked with a * are required

Basic Information

Name *

DBA *

Mailing Address *

City *

Zip Code *

Email Address *

Phone *

Cell Phone

Fax

Location Address *

City *

Zip Code *

Property Section

Main Dwelling Description *

Year Built *

Square Footage *

Insured Amount of Dwelling *

Type of Roof *

Age of Roof *

Current Deductible *

Would you like Earthquake Coverage? *

Barns, Outbuilding, Additional Dwellings

Additional Structure-1 Description

Year Built

Square Footage

Roof Type

Value

Additional Structure-2 Description

Year Built

Square Footage

Roof Type

Value

Additional Structure-3 Description

Year Built

Square Footage

Roof Type

Value

If you have more than three additional structures, provide details of the remaining structures in the notes section below.

Liability Section

(Please count horses only once.)

1. How many horses do you own? *

2. How many non-owned horses do you have boarded? *

3. How many non-owned horses do you have in training? *

4. How many horses used for breeding? *

Mares *

Stallions *

Foals/Other *

5. How many horses are used for instruction? *

Receipts *

6. Do you give riding lessons to students on their own horses? *

Receipts *

7. Do you host any horse shows? *

Number of Days *

Receipts *

8. Do you hold clinics for non students? *

Number of Days *

Receipts *

Vehicle Information

Vehicle #1

Year

Make

Model

Cost New

VIN

Vehicle #2

Year

Make

Model

Vin

Vehicle #3

Year

Make

Model

Cost New

Vin

Vehicle #4

Year

Make

Model

Cost New

Vin

If you have more than four vehicles, provide details of the remaining vehicles in the notes section below.

DRIVER INFORMATION - Anyone driving insured vehicles

Driver #1

Name

License Number

Date of Birth

Driver #2

Name

Lic#

Date of Birth

Driver #3

Name

Lic#

Date of Birth

Driver #4

Name

Lic#

Date of Birth

Additional Notes

If you have more than four drivers, provide details of the remaining drivers in the notes section below.

Please note this is preliminary information needed for an accurate quote. There is no
coverage at this time as this is a questionnaire only. Please return this form to receive a formal quote.

Please click the submit button only once.

Farm Owners / Stable Liability Questionnaire

Basic Information

Property Section

Barns, Outbuilding, Additional Dwellings

Liability Section

Vehicle Information

DRIVER INFORMATION - Anyone driving insured vehicles

Did You Know…?