CALL NOW:

Seed Industry Plus Error & Omissions Application Form

To obtain your quotation please complete the application below. If, during the process, you have any questions please feel free to contact our office utilizing our toll-free number and a farm representative will be happy to assist you.

Call us toll-free at 1-800-268-3675.

If you prefer, you may download and/or print the Seed Grower E&O application form, and mail or fax it to: Farrell Agencies Ltd., PO Box 758, 131 Palliser Way, Yorkton SK S3N 4C6. Fax 306-786-7577.





Business Information

 

Full Name:*

Form of Entity:

Corporation Name:

Address:*

 

Contact Phone Number:*

Email:

 

Are you a CSGA or CSI member?
YesNo

 

Bagged Seed Sales (ie. Canola):
$:

 

Total Gross Seed Sales (Seed intended for planting):*
Canada $:
USA $:
Other $:

 

Forage Seed Sales:
Canada $:
USA $:
Other $:

 

Custom Seed Treating Receipts (if applicable):

Custom Cleaning Receipts (if applicable):

INSURANCE HISTORY

 

Has any insurer ever declined, cancelled or restricted coverage?:

Are you aware of any occurance, fact, circumstance, or allegation, which may give rise to a claim, whether insured or not?:

Any previous losses in the past 5 years?:

Is your seed plant or farm policy with Farrell Agencies? (Further 15% discount applies)
YesNo

Limits Required:

 

I (We) hereby acknowledge that it is a direct consideration of the granting of insurance coverage provided by this program that all requirements and procedures set down by Canadian Seed Institute regarding grading, sale, handling, shipping and storage of seed/seed products are adhered to.

Comments and questions: