Agreliant | Apply

1. Account Registration

Dealer Email*

Password*

2. Seed Advisor/Location Information

Dealer Number*

Dealer Owner First Name*

Last Name*

Authorized Dealer's Business Name*

Insurance Contact - First Name*

Insurance Contact Last Name

Insurance Contact Phone*

Insurance Contact E-mail*

Dealer Address 1*

Dealer Address 2

Dealer City*

Dealer State*

Dealer Zip*

Billing Address (if different)

Address 1

Address 2

Billing City

State

Zip

3. Seed Location(s)/Value

Amount Insured/Rate: Invoice value of product and container, not to exceed policy limits described below, rates as follows:

Tier 1: Up to $2,000,000 - $1.15 per $1,000 of invoiced seed
Tier 2: Grater than $2,000,000 - $1.10 per $1,000 of invoiced seed

Property Construction Type Description:

Frame Construction (Frame) - Exterior walls of wood, brick veneer, stone veneer, wood ironclad, stucco on wood
Frame/Metal Construction (FM) - Metal exterior with wood frame
Joisted Masonry Construction (JM) - Exterior walls of masonry material (adobe, brick, concrete, gypsum block, hollow concrete block, stone, tile, or similar materials), with combustible floor and roof
Noncombustible Construction (NC) - Exterior walls, floor and supports made of metal, asbestos, gypsum or other noncombustible materials
Masonry Noncombustible Construction (MNC) - Exterior walls of masonry material (adobe, brick, concrete, gypsum block, hollow concrete block, stone, tile, or similar materials), with floor and roof of metal or other noncombustible materials
Modified Fire-Resistive Construction (MFR) - Characterized by exterior walls, floors, and roof of masonry or fire-resistive material with a fire-resistance rating of at least 1 hour but less than 2 hours
Fire-Resistive Construction (FR) - Exterior walls, floors, and roof of masonry or fire-resistive material with a fire resistance rating of at least 2 hours

Sub Dealer Enrollment

Amount Insured/Rate: Invoice value of product and container, not to exceed policy limits described below, rates as follows:

Tier 1: Up to $2,000,000 - $1.15 per $1,000 of invoiced seed
Tier 2: Grater than $2,000,000 - $1.10 per $1,000 of invoiced seed

Property Construction Type Description:

4. Submission

THE APPLICANT DECLARES THAT, AFTER INQUIRY, TO THE BEST KNOWLEDGE OF ALL PERSONS TO BE INSURED THE STATEMENTS SET FORTH HEREIN AND IN ANY ATTACHMENTS MADE HERETO ARE TRUE, AND NO MATERIAL FACTS HAVE BEEN SUPRESSED, OMITTED, OR MISSTATED.

UNDERWRITERS RESERVE THE RIGHT TO AMEND THE TERMS, CONDITIONS AND LIMITATIONS OF ANY POLICY ISSUED AS A RESULT OF THIS APPLICATION, IF SUBSEQUENT TO THE DATE OF THIS APPLICATION, BUT PRIOR TO THE INCEPTION OF SUCH POLICY, THERE ARE ANY MATERIAL ALTERATIONS TO THE INFORMATION CONTAINED HEREIN.

COMPLETION OF THIS APPLICATION DOES NOT BIND THE UNDERWRITER TO PROVIDE COVERAGE, BUT IT IS AGREED THAT THE STATEMENTS AND PARTICULARS CONTAINED HEREIN WILL BE RELIED UPON BY UNDERWRITERS IN THE EVENT A POLICY IS ISSUED. THIS APPLICATION IS SIGNED ON BEHALF OF ALL OWNERS, PRINCIPALS, PARTNERS, SHAREHOLDERS, DIRECTORS AND EMPLOYEES.

BY SUBMITTING THIS APPLICATION, THE APPLICANT AGREES THAT IN THE EVENT THE APPLICATION CONTAINS MISREPRESENTATIONS OR FAILS TO STATE FACTS MATERIALLY AFFECTING THE RISK ASSUMED BY THE INSURING COMPANY UNDER A POLICY ISSUED, THE POLICY MAY BE DEEMED NULL AND VOID.

5. Warranty Signature

By typing your name into the field below, you are affixing an electronic signature to a legal document and by doing so, you agree to be bound by the terms and provisions set forth in this application.

Name*

Signature*

Date*

Apply

1. Account Registration

2. Seed Advisor/Location Information

3. Seed Location(s)/Value

Sub Dealer Enrollment

4. Submission

5. Warranty Signature

Application Process