Assurance Insurance

All Lines of Personal and Commercial Insurance

Proudly Serving South Florida's Insurance Needs Since 1981!

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Assurance Insurance
1927 NW 9 Ave
Ft Laud., FL 33311
Ph: (954) 462-2539
Fax: (954) 462-3169

Commercial Auto Quote Form

Email Address:

First Name:

Last Name:

Business Address:

City:

State:

Zip Code:

Telephone:

Marital Status:

Date of Birth:

Social Security Number:

Type Of Business:

Business Name:

Do you transport
employees to or from work?

Type of Coverage Desired:

Stops Per Day:

Driving Radius:

Best Time To Call:

Vehicle #1

Year/Make/Model:

Vin Number:

Actual Cash Value:

Does this vehicle
have a trailer hitch?

Vehicle #2

Year/Make/Model:

Vin Number:

Actual Cash Value:

Does this vehicle
have a trailer hitch?

Vehicle #3

Year/Make/Model:

Vin Number:

Actual Cash Value:

Does this vehicle
have a trailer hitch?

Are these vehicles
for business use only?

(Please check one)

Are these vehicles for
business and personal use?

Click on the "Submit Request" button above to send your insurance quote request directly to Assurance Insurance.
Information received from this insurance quote request form sent to Assurance Insurance will be for the purpose of obtaining an insurance quote only and will not be sold, given to or distributed to any other parties. A quote will be based on the information provided and does not guarantee acceptance of the risk by us. The precise coverage afforded is subject to meeting underwriting guidelines, and the terms, conditions and exclusions of the policy as issued. By submitting this request you acknowledge that this is neither an offer to insure nor a guarantee of insurance. Completion of this form does not entitle you or your business to an insurance policy. We are licensed in Florida and will not provide quotes for persons or businesses in other states.