Request For Coverage On Horse Purchased At Public Auction 5305 Temple Hall Hwy, Granbury, TX 76049 Phone: (800) 972-0272 Fax: (817) 579-9367For “fall of the hammer” coverage on your sale purchase, please complete and submit the form below. If you have any questions or prefer to speak with an agent, please call Scott Chartier at 586-405-3052 or the on-call agent at 940-368-0880. You can also text us your contact information, hip # and purchase price to either of the numbers above and we will do the rest. Please note, coverage is bound once a confirmation email or text message is received by the sender. During normal business hours, you can always reach an agent at our office by calling 800-972-0272, option 1. Thank you for selecting Justin Insurance.Your contact detailsContact* First Last Email* Phone*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Sale* Date of Sale* MM slash DD slash YYYY Hip #* Purchase Price*Primary Use*Foal 24 hrs. - 30 daysFoal 31 days - 90 daysFoal 91 days - 1 yearEmbryo/Foal in UteroBreedingCutting/Reining/Working Cow HorseBarrel Race/Roping/RodeoShow (Western Pleasure, English, Hunt Seat)Pleasure/Trail RidingDrivingDressageEventingEnduranceHalterHunter JumperHunter Jumper (Pony)RanchingRacing (On The Track)Racing (Training Only/ Weanling or Yearling)Ranch Sorting/Team PenningOther (Please Provide Additional Information In The Box Below)Comments or QuestionsPlease select a Medical Endorsement (endorsements can be stacked)* None Colic Only Surgical Only *$7,500 Medical Assistance *Subject to value eligibility *$10,000 Medical *Subject to value eligibility *$15,000 Medical *Subject to value eligibility Disclaimer Notice - The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Further information may be required in order for a complete quote to be provided. This quote request contains some information about coverage offered but it does not list all of the conditions and exclusions that apply to the described coverage. The actual wording of the policy governs all situations. Submitting a quote request online is not an “Application” for insurance. We ask that you provide general information using this online form for the purposes of gathering information on your interest in our insurance products and services. Once we receive your online quote request submission, a Justin Insurance representative will contact you to discuss the quote and formal application process.NameThis field is for validation purposes and should be left unchanged.
