Avery & Associates: Independent Insurance Agency: Free Online Quote

Thank you for your interest. Please take a few moments to fill out the form below. By including as much information as possible, we will be able to quickly provide you with an accurate quote. The information you enter will be kept confidential.

Please note that completion of the following request for information does not constitute the purchase of insurance. No coverage may be added, changed, or bound as a result of submitting this request for information or quotation of insurance. All coverage must be confirmed by the agency in writing subject to an acceptable signed application meeting the underwriting guidelines of the Insurance Company. Avery & Associates, Inc.is licensed in the state of Florida. No solicitation of insurance is being made outside of this state.

Name of Business
Contact Name
Street Address1
Address 2:
City:	State: Zip:
Business Phone:	Home Phone:
Fax Number:	E-mail Address:
Best time to call:	A.M. P.M.

Please indicate the type of coverage you are interested in:
Personal Insurance	Personal Homeowners
Other: Please specify:

For each type of coverage you are interested in, please provide your current insurance policy information:
TYPE	Insurance Company Name	Policy Expiration Date
Commercial Property
Commercial Liability
Commercial Umbrella
Directors' & Officers' Liability
Workers' Compensation
Bond
Other: Please specify:

Please complete the following information to help us serve you better:
No. of Full-Time Employees	No. of Part-Time Employees	No. of Years in Business	Annual Sales

No. of Locations	No. of Buildings	No. of Stories	Distance to Ocean

Please briefly describe your business and clientele:

Please enter any additional comments about your insurance needs:

Please send information about your agency.

Please send requested information.

Please call so we can discuss my insurance needs in more detail.

Please call to set up an appointment.

Thank you for taking the time to complete our form.
Avery & Associates will contact you soon.

Avery & Associates, Inc.
7601 N. Federal Hwy., Suite 125-A
Boca Raton, FL 33487
Phone: 561.997.7601 Fax: 561.997.6989
Email: info@averyinsurance.com