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Please
first review “Protect Your Horse
and Your Investment” for coverage information.
If
you have any questions, please contact us at 800-890-9061.
Note: Coverage cannot be bound via the Internet
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| Contact
Name: |
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| Street
/ apt# : |
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| City: |
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| State: |
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| Zip: |
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| Tel: |
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| Fax: |
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| Email: |
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| The
best way to contact you is: |
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| Horses
Sex |
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| Purchase
Date: |
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| Horse’s
Breed |
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| Horse's
Age |
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| Horse's
Primary Use |
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| Amount
of coverage’s desired and the Horse’s Fair Market Value: |
$
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| The
horse Fair Market Value will need to be substantiated by the
recent purchase price, competition record, breeding and breeding
cost as well as professional training. |
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| Major
Medical Coverage: |
For
horses 30days through age 15 yr. |
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Horses
Insured Value must equal or exceed the Major Medical limit. |
| Major
Medical: |
Up to 7,500 |
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$5,000 surgical only |
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Stallion Infertility Accident, Sickness and/or disease |
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I do not wish to have Major Medical Coverage added
to my horse’s policy |
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Does
the above mentioned horse have any pre-existing conditions
such as but not limited to colic, laminitis, EPM, etc.
If yes, please give details: |
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Would
you like to have a quote on other horses?(fill out horse information
only) |
