Stroud National Agency, Inc.
Farm and Ranch Insurance Quote Request (Admitted)

Are you an insurance agent seeking an Admitted quote?

Products

To learn more about the farm and ranch insurance coverages we offer and our appetite, please visit our Products page.

Have Questions?

For assistance with your quote and / or additional guidance with regard to appetite and requirements, please contact us.

Farm & Ranch Insurance
Admitted Quote Request Form

Please complete the form below.
The form will generate a PDF that you can save or print for your records, and we’ll follow up with you shortly!

"*" indicates required fields

1AGENCY INFO

2APPLICANT INFO

3LOCATION INFO

4LIABILITY COVERAGE(S)

5DWELLING

6DWELLING INFO

7PROTECTIVE DEVICES

8SCHEDULED FARM PERSONAL PROPERTY

9BARNS AND OUTBUILDINGS

10OPTIONAL PROPERTY COVERAGES

11APPLICANT'S LOSS HISTORY

12Non-Renewed or Lapse in Coverage

This field is for validation purposes and should be left unchanged.

AGENCY INFO

Agency Name*

First

Phone*

Contact Name*

Agency Code

Enter Agency Code here. If a new agent, write NEW.

Fax

Email*

APPLICANT INFO

Full Name*

First

Entity Type:**

Owner/Principal Name*

First

Owner/Principal Date of Birth*

MM slash DD slash YYYY

Date of Birth*

MM slash DD slash YYYY

Owner/Managing Member Name*

First

Owner/Managing Member Date of Birth*

MM slash DD slash YYYY

Managing Partner Name*

First

Managing Partner Date of Birth*

MM slash DD slash YYYY

Partner Name*

First

Partner Date of Birth*

MM slash DD slash YYYY

Owner/Principal Name*

First

Owner/Principal Date of Birth*

MM slash DD slash YYYY

Date of Birth*

MM slash DD slash YYYY

Trustee Name*

First

Trustee Date of Birth*

MM slash DD slash YYYY

Mailing Address*

City*

State*

Zip*

County*

Phone*

Farm Type*

Total Acres

Total Locations

Locations w Buildings

Last Annual Receipts

Requested Effective Date

MM slash DD slash YYYY

LOCATION INFO

Same as Mailing Address?

Yes

Address*

City*

County*

State*

Zip*

Section

Township

Range

Inside City Limits?*

Yes

LIABILITY COVERAGE(S)

Liability Limit

Medical Payments Limit:

Any business activities other than farming or ranching conducted at any insured location?*

If yes, please describe

Are there any dogs on the premises? (Y,N)*

Breed

Optional Coverages

Any ATV’s?*

ATV's Information*

Year*

Make/Model*

Serial Number*

Limits*

Any Horses?*

Please Describe (How Used, How Many?)*

DWELLING

Costimator is required for all dwellings over $500,000; Must be insured to at least 80% of value.

Perils:

Basic

Broad

Special/Broad

Special

Contents Only

Deductible:

$1,000

$2,500

$5,000

$10,000

$25,000

Contents Limit:

40%

50%

60%

70%

80%

Valuation:*

Replacement Cost

Actual Cash Value

How many dwellings?*

The primary dwelling, even if it’s not at a farm location, generally needs to be included in order to quote.

DWELLING INFO

First Dwelling Location

At Which Location # ?**

Year Built*

Mobile Home*

Living Area Total sq ft*

Select:

Primary

Secondary

Tenant Occupied

Roof Type*

Construction*

If Mobile, foundation*

Yes

Amount of Insurance: $*

Value at 100% Replacement Cost: $

Updates

Wiring Year

Plumbing Year:

Heating Year

Roof Year

Garage sq ft

Garage type:

Attached

Detached

Wood Stove:*

Yes

Pool/Trampoline (Y,N)*

Yes

If Yes, Please provide details in NOTES at the end of the form

Details*

Second Dwelling Location

At Which Location # ?**

Year Built*

Mobile Home*

Living Area Total sq ft*

Select:

Primary

Secondary

Tenant Occupied

Roof Type*

Construction*

If Mobile, foundation*

Yes

Amount of Insurance: $*

Value at 100% Replacement Cost: $

Updates

Wiring Year

Plumbing Year:

Heating Year

Roof Year

Garage sq ft

Garage type:

Attached

Detached

Wood Stove:*

Yes

Pool/Trampoline (Y,N)*

Yes

If Yes, Please provide details in NOTES at the end of the form

Details*

Third Dwelling Location

At Which Location # ?**

Year Built*

Mobile Home*

Living Area Total sq ft*

Select:

Primary

Secondary

Tenant Occupied

Roof Type*

Construction*

If Mobile, foundation*

Yes

Amount of Insurance: $*

Value at 100% Replacement Cost: $

Updates

Wiring Year

Plumbing Year:

Heating Year

Roof Year

Garage sq ft

Garage type:

Attached

Detached

Wood Stove:*

Yes

Pool/Trampoline (Y,N)*

Yes

If Yes, Please provide details in NOTES at the end of the form

Details*

Fourth Dwelling Location

At Which Location # ?**

Year Built*

Mobile Home*

Living Area Total sq ft*

Select:

Primary

Secondary

Tenant Occupied

Roof Type*

Construction*

If Mobile, foundation*

Yes

Amount of Insurance: $*

Value at 100% Replacement Cost: $

Updates

Wiring Year

Plumbing Year:

Heating Year

Roof Year

Garage sq ft

Garage type:

Attached

Detached

Wood Stove:*

Yes

Pool/Trampoline (Y,N)*

Yes

If Yes, Please provide details in NOTES at the end of the form

Details*

Fifth Dwelling Location

At Which Location # ?**

Year Built*

Mobile Home*

Living Area Total sq ft*

Select:

Primary

Secondary

Tenant Occupied

Roof Type*

Construction*

If Mobile, foundation*

Yes

Amount of Insurance: $*

Value at 100% Replacement Cost: $

Updates

Wiring Year

Plumbing Year:

Heating Year

Roof Year

Garage sq ft

Garage type:

Attached

Detached

Wood Stove:*

Yes

Pool/Trampoline (Y,N)*

Yes

If Yes, Please provide details in NOTES at the end of the form

Details*

PROTECTIVE DEVICES

Protective Devices:*

Yes

If Yes, describe:*

Fire Protection: Within 5 miles of fire dept:*

Yes

Within 1000 ft of hydrant:*

Yes

ISO Rating

SCHEDULED FARM PERSONAL PROPERTY

Pieces of equipment?*

ITEM 1

Year*

Make*

Serial Number*

Model*

Peril*

Limit*

Ded*

ITEM 2

Year*

Make*

Serial Number*

Model*

Peril*

Limit*

Ded*

ITEM 3

Year*

Make*

Serial Number*

Model*

Peril*

Limit*

Ded*

ITEM 4

Year*

Make*

Serial Number*

Model*

Peril*

Limit*

Ded*

ITEM 5

Year*

Make*

Serial Number*

Model*

Peril*

Limit*

Ded*

BARNS AND OUTBUILDINGS

Number of Barns and Outbuildings*

Typical Use*

Structure Function/Use

Type*

Open/Closed*

Year*

Sq Ft*

Construction*

If Other, please provide details in NOTES at the end of the form

Roof Type*

Peril*

Limit*

Ded*

At Which Location # ?*

RC or ACV*

RC (Replacement Cost)

ACV (Actual Cash Value)

Typical Use*

Structure Function/Use

Type*

Open/Closed*

Year*

Sq Ft*

Construction*

If Other, please provide details in NOTES at the end of the form

Roof Type*

Peril*

Limit*

Ded*

At Which Location # ?*

RC or ACV*

RC (Replacement Cost)

ACV (Actual Cash Value)

Typical Use*

Structure Function/Use

Type*

Open/Closed*

Year*

Sq Ft*

Construction*

If Other, please provide details in NOTES at the end of the form

Roof Type*

Peril*

Limit*

Ded*

At Which Location # ?*

RC or ACV*

RC (Replacement Cost)

ACV (Actual Cash Value)

Typical Use*

Structure Function/Use

Type*

Open/Closed*

Year*

Sq Ft*

Construction*

If Other, please provide details in NOTES at the end of the form

Roof Type*

Peril*

Limit*

Ded*

At Which Location # ?*

RC or ACV*

RC (Replacement Cost)

ACV (Actual Cash Value)

OPTIONAL PROPERTY COVERAGES

Description

Limit of Insurance (if applicable)

Description

Limit of Insurance (if applicable)

ADDITIONAL LOCATION ADDRESSES

Additional Location 2 (Two)

Additional Location 3 (Three)

Additional Location 4 (Four)

APPLICANT'S LOSS HISTORY

(Last 5 years, regardless of location)

Has the applicant had any losses within the past 5 years?

Yes

Consent*

By not declaring losses on this form, I am stating that the applicant certifies that there is no loss history to report over the past 5 years.*

If exact date of loss is not available, please give best estimate.

Date of Loss

Description

Amount

Date of Loss

Description

Amount

Date of Loss

Description

Amount

Expiration Date of Existing Policy*

Carrier of Existing/Expiring Policy*

Non-Renewed or Lapse in Coverage

Non-Renewed or Lapse in Coverage?*

Yes

Reason

Premium of Existing/Expiring Policy

Notes or comments about the risk

Click the SUBMIT button below to send your form electronically.

You will receive a print / download link of your submission after sending.

File Upload

Accepted file types: jpg, gif, png, pdf, Max. file size: 20 MB.

NOTE: This quote request form is intended for licensed insurance agents only. If you are an insurance consumer, please contact your local independent agent.

Serving America’s Farmers & Ranchers for 60+ years.

Contact our dedicated team. We’re ready to help!

800-654-4056

Stroud National Agency, Inc.
Farm and Ranch Insurance Quote Request (Admitted)

Are you an insurance agent seeking an Admitted quote?

Products

Have Questions?

Farm & Ranch Insurance
Admitted Quote Request Form

AGENCY INFO

APPLICANT INFO

LOCATION INFO

LIABILITY COVERAGE(S)

DWELLING

DWELLING INFO

First Dwelling Location

Second Dwelling Location

Third Dwelling Location

Fourth Dwelling Location

Fifth Dwelling Location

PROTECTIVE DEVICES

SCHEDULED FARM PERSONAL PROPERTY

ITEM 1

ITEM 2

ITEM 3

ITEM 4

ITEM 5

BARNS AND OUTBUILDINGS

OPTIONAL PROPERTY COVERAGES

ADDITIONAL LOCATION ADDRESSES

APPLICANT'S LOSS HISTORY

If exact date of loss is not available, please give best estimate.

Non-Renewed or Lapse in Coverage

Click the SUBMIT button below to send your form electronically.

Serving America’s Farmers & Ranchers for 60+ years.

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Loafing Shed
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Quonset Hut
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Stable
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Well House
Bunk House
Grain Bin
Hay Barn
Quonset Hut
Office
Corrals & Pens
Silo
Ground Mounted Solar Panels

Stroud National Agency, Inc. Farm and Ranch Insurance Quote Request (Admitted)

Are you an insurance agent seeking an Admitted quote?

Products

Have Questions?

Farm & Ranch InsuranceAdmitted Quote Request Form

AGENCY INFO

APPLICANT INFO

LOCATION INFO

LIABILITY COVERAGE(S)

DWELLING

DWELLING INFO

First Dwelling Location

Second Dwelling Location

Third Dwelling Location

Fourth Dwelling Location

Fifth Dwelling Location

PROTECTIVE DEVICES

SCHEDULED FARM PERSONAL PROPERTY

ITEM 1

ITEM 2

ITEM 3

ITEM 4

ITEM 5

BARNS AND OUTBUILDINGS

OPTIONAL PROPERTY COVERAGES

ADDITIONAL LOCATION ADDRESSES

APPLICANT'S LOSS HISTORY

If exact date of loss is not available, please give best estimate.

Non-Renewed or Lapse in Coverage

Click the SUBMIT button below to send your form electronically.

Serving America’s Farmers & Ranchers for 60+ years.

Stroud National Agency, Inc.
Farm and Ranch Insurance Quote Request (Admitted)

Farm & Ranch Insurance
Admitted Quote Request Form