Stroud Farm and Ranch Insurance Quote Request

Are you an insurance agent seeking a quote?

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!

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

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

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

"*" indicates required fields

Step 1 of 11

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:**

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

Dogs on Premises

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

Any Wildfire or Brush concerns within ¼ mile of Structures/Property?*

If yes, please describe:*

DWELLING INFO

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

PROTECTIVE DEVICES

Protective Devices:*

Yes

If Yes, describe:*

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?*

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.

Name

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

Stroud Farm and Ranch Insurance Quote Request

Are you an insurance agent seeking a quote?

AGENCY INFO

APPLICANT INFO

LOCATION INFO

LIABILITY COVERAGE(S)

DWELLING

DWELLING INFO

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.

Click the SUBMIT button below to send your form electronically.

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