Request Quote | Chartier Agency

Your Information

Name*

First Last

Business Name

Email*

Phone*

Mailing Address*

Street Address City State ZIP Code

Type of Coverage

How can we help you?*

Equine Mortality & Medical

Farm and Ranch

Commercial Equine Liability and Equine Care, Custody & Control

Horse Show Insurance

Other

Tell us more about your insurance needs

Equine Mortality & Medical

Horse #1 Information

Horse's Name*

Age*

year born, if a foal please include its date of birth

Breed*

Sex*

Horse’s Primary Use*

Purchase Date*

How was the horse acquired*

Requested Insured Value*

*If requesting a value above the purchase price, the value is subject to underwriting approval based on the horse’s performance record, level of training since purchase, points won, etc.)

Purchase Price*

In the last 12 months, has your horse had any of the following? (check all that apply)*

Not Applicable

Illness

Injury

Surgery

Lameness

Are any medical endorsements desired on the above horse? Select one or more of the following*

None

$15,000 Major Medical

$10,000 Major Medical

$7,500 Major Medical

Surgical Only

Colic Only (Medical or Surgical Colic)

Would you like a quote for a second horse?*

Yes

Horse #2 Information

Horse's Name*

Age*

year born, if a foal please include its date of birth

Breed*

Sex*

Horse’s Primary Use*

Purchase Date*

How was the horse acquired*

Requested Insured Value*

*If requesting a value above the purchase price, the value is subject to underwriting approval based on the horse’s performance record, level of training since purchase, points won, etc.)

Purchase Price*

In the last 12 months, has your horse had any of the following? (check all that apply)*

Not Applicable

Illness

Injury

Surgery

Lameness

Are any medical endorsements desired on the above horse? Select one or more of the following*

None

$15,000 Major Medical

$10,000 Major Medical

$7,500 Major Medical

Surgical Only

Colic Only (Medical or Surgical Colic)

Would you like a quote for a third horse?*

Yes

Horse #3 Information

Horse's Name*

Age*

year born, if a foal please include its date of birth

Breed*

Sex*

Horse’s Primary Use*

Purchase Date*

How was the horse acquired*

Requested Insured Value*

*If requesting a value above the purchase price, the value is subject to underwriting approval based on the horse’s performance record, level of training since purchase, points won, etc.)

Purchase Price*

In the last 12 months, has your horse had any of the following? (check all that apply)*

Not Applicable

Illness

Injury

Surgery

Lameness

Are any medical endorsements desired on the above horse? Select one or more of the following*

None

$15,000 Major Medical

$10,000 Major Medical

$7,500 Major Medical

Surgical Only

Colic Only (Medical or Surgical Colic)

Would you like a quote for a fourth horse?*

Yes

Horse #4 Information

Horse's Name*

Age*

year born, if a foal please include its date of birth

Breed*

Sex*

Horse’s Primary Use*

Purchase Date*

How was the horse acquired*

Requested Insured Value*

*If requesting a value above the purchase price, the value is subject to underwriting approval based on the horse’s performance record, level of training since purchase, points won, etc.)

Purchase Price*

In the last 12 months, has your horse had any of the following? (check all that apply)*

Not Applicable

Illness

Injury

Surgery

Lameness

Are any medical endorsements desired on the above horse? Select one or more of the following*

None

$15,000 Major Medical

$10,000 Major Medical

$7,500 Major Medical

Surgical Only

Colic Only (Medical or Surgical Colic)

Farm and Ranch

Property Address*

Street Address City State ZIP Code

Mailing address same as the property address?*

Yes

Mailing Address*

Street Address City State ZIP Code

Total number of acres*

Type of Operation(s)*

Is this a new purchase or do you have existing coverage?*

New Purchase

Existing Coverage

Commercial Equine Liability
and Equine Care, Custody & Control

Property Address*

Street Address City State ZIP Code

Mailing address same as the property address?*

Yes

Mailing Address*

Street Address City State ZIP Code

Do you own or lease this property?*

Own

Lease

Type of Operation(s)*

Horse Show

Type of Horse Show?*

Date Show Starts*

MM slash DD slash YYYY

Date Show Ends*

MM slash DD slash YYYY

Are additional days for setup and takedown needed? What days?*

Property Address*

Street Address City State ZIP Code

Mailing address same as the property address?*

Yes

Mailing Address*

Street Address City State ZIP Code

Disclaimer

This is not an application for insurance. If you elect to submit information for a quote, it does not mean you are applying for or have been approved for an insurance policy. The details you provide are solely used to generate a premium estimate for the type of insurance you are interested in. Also, it doesn't guarantee that you are eligible for the policy or that the final price or terms won't change after a full application and underwriting process. The actual terms, conditions, coverage, and exclusions are determined by the specific insurance policy contract, not the quote. Once we receive your online quote submission, a Chartier Agency representative will contact you to gather additional information if needed, prepare a quote and discuss the formal application process.

How did you learn about us?*

RequestYour Free Quote

Let’s talk about your Insurance needs.

Horse #1 Information

Horse #2 Information

Horse #3 Information

Horse #4 Information