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Farm Quote Form


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information
First Name
Required
Last Name
Required
Street
Required
City
Required
State
Required
ZIP / Postal Code
Required
E-Mail Address
Required
Primary Phone Number
Required
Alternate Phone Number
Optional
Date of Birth
Required
/ /
Social Security Number (please include if possible)
Optional
Dwelling Information
Year Built
Required
Roof Type
Required
Construction Type
Required
Number of families living in home
Required
Square Footage
Required
Does the home have a basement?
Required
Is there a garage? (If so, list how many cars)
Required
Porches? (List if open/enclosed and square feet)
Required
How many bathrooms? (Specify full or half)
Required
Estimated Value
Required
Dogs
Required
Pool
Required
Trampoline
Required
Are there any wood stoves in the house?
Required
Are there any smokers in the house?
Required
Claims/Property Losses in Past 5 Years (Please Explain)
Optional
Farm and Equipment Information
Do you actively work agriculture land yourself - growing crops or raising animals beyond the level of personal use only?
Required

Do you have 100 acres or more of land used for agriculture?
Required

Do you own more than 500 acres of land with no buildings on it?
Required

Do you own any farm animals?
Required

Do you own 7 or more animals for personal use only?
Required

Are there any barns on the property?
Required

Do you own any mobile machinery?
Required

Do you sell your own produce?
Required

Do you have a roadside stand?
Required


Do you offer "pick your own" produce?
Required


Do you own any additional farm properties?
Required

How did you hear about us?
Required
Additional Notes
Optional
Submission Validation
Required
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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