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Home > Farm > Farm Insurance Quote
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Farm Insurance Quote


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Farmer
First Name *
Last Name *
The farm is owned by a(n) *
If other, please specify:
Other
Farm
Farm Name *
Farm Type *
If other, please specify:
Other
Street *
City *
State *
ZIP / Postal Code *
Primary Phone Number *
E-Mail Address *
Please provide mailing address if different from main farm location.
Street Address
City, State. ZIP Code
Farm Employees
Do you have full time employees working more than 6 months a year? *

If yes, how many?
Do you have part time employees working 2 - 6 months a year? *

If yes, how many?
Do you have part time employees who work 2 months or less a year? *

If yes, how many?
Farm Buildings and Dwellings
Are there dwellings and/or farm buildings on any of the properties? *

Number of Farm Buildings
Number of Dwellings
Are they rented out to others?

Farming Activities
Acres *
Do you raise livestock? *

If yes, what kind? Check all that apply.


Hold down the Ctrl Key to make multiple selections.
Do you raise crops? *

If yes what crop(s)?
Is any farmland rented to others to farm? (grazing, hay cutting, crops, etc.)

If yes, how many acres?
What farm products do you keep in stock? Check all that apply.


Hold down the Ctrl Key to make multiple selections.
What farm supplies do you keep in stock? Check all that apply.


Hold down the Ctrl Key to make multiple selections.
What farm machinery do you own or lease? Check all that apply


Hold down the Ctrl Key to make multiple selections.
Submission Validation
Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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412 E Philadelphia Ave. | Boyertown PA 19512
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