 |
All Lines of Personal and Commercial Insurance
Proudly Serving South Florida's Insurance Needs Since 1981! |
|
|
|
Request a Quote
Home
Locations
FAQ
Personal
Car Insurance
Homeowners Insurance
Motorcycle Insurance
Watercraft Insurance
Business
General Liability
Commercial Auto
Worker Compensation
Assurance Insurance
1927 NW 9 Ave
Ft Laud., FL 33311
Ph: (954) 462-2539
Fax: (954) 462-3169
|
Workers Compensation Quote Form
|
|
|
(Info needed on all employees:
Name, DOB, SS#, Duties)
Info For Employee 1:
Info For Employee 2:
Info For Employee 3:
Info For Employee 4:
Info For Employee 5:
Info For Employee 6:
Info For Employee 7:
Info For Employee 8:
Info For Employee 9:
Info For Employee 10:
|
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.
|