AKC© Dog Club Quote Request

Are you an insurance agent or broker? *

Yes

No

Club Name *

Applicant First Name *

Applicant Last Name *

Email Address *

Phone Number *

Address

Street Address *

City *

State *

Zip *

Are you currently an AKC affiliated club? *

Yes

No

Number of Club Members

Do your club operations include dog training to the general public? *

Yes

No

If so, what is the Gross Annual Revenue from training to the general public?

Does your club hold fundraisers? *

Yes

No

If yes, what is the Gross Annual Revenue from Fundraisers?

What is the desired club-owned property limit?

$1,000 per item/$5,000 Aggregate limits (standard limits)

$5,000 per item/$10,000 Aggregate limits (standard limits)

$10,000 per item/$15,000 Aggregate limits (standard limits)

$15,000 per item/$30,000 Aggregate limits (standard limits)

How did you hear about us? *

If "Other" Please Specify

Please list any additional comments