CARTER AGENCY Insurance Real Estate

“A Name You Can Trust” 208 N Maple St – PO Box 306 – Creston, IA 50801 641-782-8516 / 888-828-8516 / Fax: 641-782-4664

E-Mail: carteragency@carteragcy.com

Licensed Insurance Agents in Iowa, Missouri, Nebraska & Licensed REALTORS® in Iowa.

Farm Insurance Quote Request Form Please fill out as much or as little as you like and one of our Agents will contact you in the near future.
	First & Last Name:
	Street Address:
	City, State & Zip:
	E-Mail Address:
Telephone:		Fax:
	Current Insurance Information
Insurance Company Name:
Any Losses in last 3 yrs?:
Premium Amount:		Policy Exp. Date:
Describe the Type of Coverage you Currently have:
	About Your Farm
# of Locations	# of Total Acres	Yrs. in Business	# of Locations with Outbuildings

# of Employees	Livestock	Annual Gross Sales	Square Footage?

	# of Acres	Types of Crops




	General Information About Home:
Year home built in:		Total Square Feet:
Yrs @ present address:
Home Type:		Home Construction:
Roof Type:		Garage Type:
Age of roof:		Garage:
# of Bedrooms:		# of Fireplaces:
# of Bathrooms:		Exterior:
Dwelling Deductible:
Contents Deductible:
Dwelling Coverage:
Contents Coverage:

Please describe your farming operation and any additional comments here:

By sending this form, you declare that the above information is true and understand that this is a request for a quotation only and are under no obligation. Quote subject to applicant meeting underwriting criteria and rate availability. Consumer reports may be obtained as part of the insurance underwriting process. The reports procured by Carter Agency may include a credit score and/or your driving record in order to assess your insurability. By hitting the send button, you are authorizing Guaranty Insurance to obtain such reports.