Horse Owner Liability Quote Request

All fields marked (*) are required.

Are you an insurance agent or broker? *

Yes

Applicant First Name *

Applicant Last Name *

Phone Number

Fax

Email Address *

Address

Street Address *

City *

State *

Zip *

How many personally owned/leased horses do you need liability coverage for? *

Will any of the above equines be used for Equine Assisted Activities/Therapies? (example: Nursing home visits, school programs, or similar activities)

Yes

Will you need Additional Insured Certificates?

Yes

If you answered "Yes" above, how many Additional Insureds?

How did you hear about us? *

If "Other" Please Specify

Please list any additional comments