Hunting Lease Application

Thank you for your interest in a hunting lease through Farmers State Bank. All applications received will be on file for 90 days from the date received by Farmers State Bank. After that time period, a new application must be submitted if you desire to be considered. Applications must be filled out through the online form below.

If you have not received notification from Farmers State Bank that we have received your application, please call 217-285-6228 to confirm receipt of application.

Hunting Lease Applicant Information

Name

Contact Person

Mailing Address

Phone Number

Email Address

Enter Offer:

Limit of Liability Offered: $1,000,000 Occurrence/$2,000,000 Aggregate

Submitter Information

Application Submitted by

Name

Contact Person

Address

Phone

By clicking submit, I certify that the information I have given on this application is complete and correct. I understand my failure to provide complete, accurate and truthful information on the application may be grounds for denial. *To certify your responses, review your input and provide an electronic signature (type your name) in the submitter information section and click submit.

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Hunting Lease Applicant Information

Limit of Liability Offered: $1,000,000 Occurrence/$2,000,000 Aggregate

Submitter Information

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