Dog/Pet Club Quote Request (non-AKC)

Are you an insurance agent or broker? *

Yes

No

Club Name *

Type of Club

Applicant First Name *

Applicant Last Name *

Email Address *

Phone Number

Address

Street Address *

City *

State *

Zip *

Please indicate club's annual revenue *

If yes, what is the desired club-owned property limit?

$1,000 per item/$5,000 Aggregate limits (standard limits)

$5,000 per item/$10,000 Aggregate limits

$10,000 per item/$20,000 Aggregate limits

$15,000 per item/$30,000 Aggregate limits

Do you provide pet training?

Yes

No

If yes, choose one of the following:

Training only to club members

Training to public for a fee (please include annual income below)

Annual income for training to public

Does your club hold fundraisers? *

Yes

No

If yes, what is the Gross Annual Revenue from Fundraisers?

Does the club use live ammunition or horses during any events?

How did you hear about us? *

If "Other" Please Specify

Please list any additional comments