Fehr Equine Insurance Form

What is your first name? *

What is your last name? *

What is your phone number? *

Please enter your email. *

Please enter your primary mailing address. *

Check this box if the mailing address and the horse stabling address are the same.

What is the horse stabling address? *

Where are your horses boarded?

What is the breed of horse?

What is the age of the horse?

Is the horse Mare/Gelding/Stallion?

Is the horse used for breeding or currently in foal?

What is the use of the horse? (Select all that apply)

Please provide a brief description of the use of the horse.

What discipline is the horse currently being used for?

Please enter the other discipline(s) your horse is involved in.

What is the purchase price?

Please enter the horses' name and requested mortality coverage limits below.

Please select your desired medical insurance limit.

Please explain any existing medical conditions?

Is the horse currently insured?

What is the name of the insurance company?

Please use this field to upload any relevant documents. (ie. Current policy declarations pages, etc...)

Please enter comments about the horse or any current conditions of the horse below.

Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.

Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes.

This field is for validation purposes and should be left unchanged.

Fehr Equine Insurance Form

Documents and Comments

Kerry Shapiro

RiskRevu^TM Newsletter

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Fehr Equine Insurance Form

Documents and Comments

Kerry Shapiro

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RiskRevuTM Newsletter

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RiskRevu^TM Newsletter