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

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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.

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Assurance Insurance, Inc.
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