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Application and Forms

Applications and forms are available to view and download at your convenience.
All forms require various information and signatures.

They must be completed, signed as appropriate, and returned to Prairie States Insurance Agency Inc. before coverage can be bound. Please contact us for we are glad to answer any questions and provide any help with completing applications and forms.  

Instructions: Click on a FORM below to open in Adobe Reader on your computer.

Click on the printer icon in the menu bar and print a copy of the form.

After completing the form and signing please fax it to 405-235-5225 or scan the completed and signed form and email it to Deborah

get adobe reader

Alpaca Application and Forms
Alpaca Declaration of Health pdficon small
Alpaca Veterinarian Certification Form pdficon small
Alpaca Insurance Application pdficon small
Insurance Payment Options pdficon small

 

Cattle Application and Forms
Cattle Declaration of Health pdficon small
Cattle Veterinarian Certification Form pdficon small
Cattle Insurance Application pdficon small
Insurance Payment Options pdficon small
Livestock (pasture/herd) Specified Perils  

 

Equine Application and Forms
Equine Mortality Insurance Application pdficon small
Equine Veterinary Certificate of Examination pdficon small
Commercial Equine Liability Application pdficon small

 

Exotic Animals Since this coverage is breed and value specific, it will be best for you to contact Deborah with details of the risk, or complete and email the Animal Mortality Application and we’ll respond within 24 hours.

Exotic Animal Application and Forms

Since this coverage is breed and value specific, it will be best for you to call or email with details of the risk, or complete and email the Animal Mortality Application and we’ll respond within 24 hours.

Animal Veterinary Certificate of Examination pdficon small

Animal Mortality Insurance Application - AEIG Mortality Coverage Description

pdficon small

 

Farm and Ranch Application and Forms
EquiFarm Application pdficon small
Personal Horse Owners Liability pdficon small
Commercial Equine Insurance Liability Application pdficon small
Horse Club Liability Application pdficon small
Prairie States Livestock Quick Quote pdficon small
Prairie States Liability Quick Quote pdficon small
Trainer/Instructor pdficon small
Clubs and Associates