🚜 Farm Insurance Info Sheet

Home, outbuildings, equipment, livestock, farm liability, autos, valuables & umbrella — one secure sheet and we shop it across your farm markets. Fill what applies; skip the rest. Prefer to talk? Call and we'll take it over the phone.

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1. Named insured & contact

First named insured *

Date of birth

Occupation

Employer

Second named insured

Date of birth

Phone *

Email *

Business entity

Federal ID / EIN (if a business)

Farm business started

2. Home / dwelling

Dwelling type

Occupancy

Location address

City

State

Zip

Mailing address (if different)

New purchase?

Year built

Square footage

Roof type

Roof shape

Foundation type

Construction type

Home protection

Within 5 mi of fire dept Within 1000 ft of hydrant Central burglar alarm Central fire alarm

Home coverage (current carrier · dwelling value · liability · contents · deductible)

Current carrier

Dwelling value / rebuild

Liability limit

Contents amount

Deductible

3. Farm property & operation Type of farm / ranch (check all that apply) Describe the operation (and any incidental business — agritourism, roadside stand, custom farming)

Acres — total

Acres — cultivated

Acres — pasture

Annual farm gross receipts

County

Distance to nearest hydrant

Distance to fire station

Outbuildings / structures (barns, silos, shops, grain bins — description & value)

Structure	Year	Value

Farm equipment / machinery (tractors, combines, implements)

Equipment	Year	Value

Livestock (type, head count, value)

Type	Head	Total value

Grain / bin storage (crop, approx. bushels stored, and each bin's capacity)

Crop	Approx. bushels stored	Bin capacity (bu)

Farm liability type

Farm liability limit wanted

# full-time employees

# part-time employees

Total annual payroll

Want animal-collision coverage (livestock struck on the road)

4. Autos & drivers Vehicles

Year	Make	Model	VIN	Usage

Drivers

Auto coverage

Current carrier

Liability limit

Collision deductible

Comprehensive deductible

Agreed value (if any)

5. Valuable articles (jewelry, fine art, furs, silverware, cameras, collectibles)

Jewelry

Fine art

Furs

Silverware

Cameras

Other / misc.

Itemized or blanket?

Jewelry kept in a bank vault?

6. Coverages & limits wanted (check any; add a limit if you have one in mind)

Umbrella / excess liability

Crop insurance (MPCI / crop-hail)

Farm / premises liability

General liability

Employers liability

Farm products / product liability

Equipment / inland marine (blanket)

Other homes/residences to cover

Loss history (any losses in the last 5 years?)

7. General information

Year-round water supply usable for fire protection (well/pond/hydrant)? Any wood or coal-fired stoves in buildings? Burglar and/or fire alarms on the premises? Is the entire premises occupied year-round? Does the applicant do their own equipment maintenance? Independent contractors hired for any farming operations? Any policy cancelled or non-renewed in the last 5 years? Does the applicant have any other business?

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