Pet Club (non AKC) Quote Request Pet Club Quote Request (non AKC) Are you an insurance agent or broker?* Yes No Club Name* Type of Club Contact Name* First Last Address* Street Address Address Line 2 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 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? Yes No If yes, what is the desired limit? $1,000 $5,000 $10,000 Do you provide pet training? Yes No If yes, choose one of the following: Training only to club members Training to public for a fee (please include annual income below) Annual income for training to public How 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 Details Please list any additional comments Δ