Quick Quote Equine Mortality Application

Are you a new client?*

YesNo

Who is your agent?*

I'm not sureColton CampbellCourtney WilsonSarah Schwarzer

Name*

Cell Phone*

Email Address*

example@example.com

Horse's Name (Show Name)*

Primary Use*

Hunter/Jumper, Dressage, Barrel Racing, Etc.

Year Foaled*

Purchase Price (not lease price)*

Put N/A if you don't know the most recent or current purchase price.

Breed*

Type*

Sex*

Amount Insured (Mortality Coverage)*

You may insure the horse up to 3 times the lease value, the most recent purchase price, or increased coverage can be justified through show records, training, and/or shipping costs.

Desired Coverage:*

Mortality$15K Major Medical (ONLY for horses insured over $20K Mortality)$10K Major Medical (ONLY for horses insured over $20K Mortality)$7.5K Medical Assistance (ONLY for horses insured over $20K Mortality)

Please refer to the medical coverage PDF before deciding to choose a medical plan.

If a Medical Plan is selected above, COLIC & SURGICAL coverages are included in your selected limits.

Other Coverage Options:

$10K Surgical Only (May be paired with Colic Only)$10K Colic Only (May be paired with Surgical Only)Loss of Use (ONLY for horses insured over $100K Mortality)Air-Transit Coverage (for horses flying)