Pet Club (non AKC) Quote Request Pet Club Quote Request (non AKC) Are you an insurance agent or broker?*YesNoClub Name*Type of ClubContact Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact PhoneContact Email* Please indicate club's annual revenue*Under $100,000$100,001 - $200,000$200,001 - $300,000Do you want to include club owned equipment?YesNoIf yes, what is the desired limit?$1,000$5,000$10,000Do you provide pet training?YesNoIf yes, choose one of the following:Training only to club membersTraining to public for a fee (please include annual income below)Annual income for training to publicHow did you hear about us*Internet Search (Please specify words searched below)American Kennel ClubFriend/ReferralLinkedInTrade Show (Please specify below)United Kennel ClubOther Club or Organization (Please specify below)Other/Please Specify DetailsPlease list any additional comments