Hunt Lease Insurance Application Club Name* Club Representative* Email* Mailing Address of Club Representative* Street Address City State / Province / Region ZIP / Postal Code Phone* Total # of Acres Leased* LANDOWNER INFORMATION How Many Land Owners Does Your Club Lease From?* 1234 Land Owner 1 Name* 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 Land Location 1 (County, City, State Required)* Number of Acres:* Land Owner 2 Name* Address* Street Address City State / Province / Region ZIP / Postal Code Land Location 2 (County, City, State Required)* Number of Acres* Land Owner 3 Name* Address* Street Address City State / Province / Region ZIP / Postal Code Land Location 3 (County, City, State Required)* Number of Acres* Land Owner 4 Name* 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 Number of Acres* Land Location 4 (County, City, State Required)* Premium Your application indicates that you have up to 3,300 acres Quantity* Price: $330.00 Quantity Minimum Premium (Input 1 in quantity if this is correct) How many acres do you lease over 3,300? (Final premium computation will be rounded to the next whole dollar.) Quantity* Price: $0.10 Quantity Total Premium Due $0.00 How would you like to pay for this policy today?* Credit Card (recommended) - An email will be sent to you with a credit card link shortly. Check via email - please email a completed copy of a check made payable to Sadler & Company to insurance@sadlerco.com. Do not mail the check. Check via fax - please fax a completed copy of a check made payable to Sadler & Company to 803-256-4017. Do not mail the check. Check via mail - please mail a check Payable to Sadler & Company to PO Box 5866, Columbia SC 29250 The coverage will be effective when both the application and the premium is received, whichever date is later. All certificates will be emailed. Warranty This is a Master Policy. The policy has an effective date of August 1, 2016 to August 1, 2017. Please check below that you understand and agree with the following:* Premiums are 100% fully earned and there is No Refund of premium if the policy is cancelled mid-term. Regardless of the effective date, the policy will expire 08/01/2017. By completing this application, I certify that the information listed above is correct and complete.
