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We Are Independent Agents!
We Are An Independent Insurance Agency...

 
As an independent agency, we are dedicated to serving YOU! Polo Insurance has been in business 22 years!

We represent several leading insurance companies rather than any single provider. Therefore, we have the ability to continually monitor the marketplace and offer you the best possible rates.

Our goal is to provide you the highest level of customer service and dedicate our resources to meet your needs and earn your trust. our success is based on your continued satisfaction.

On-Line Workers Comp
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!


Your Personal / Company Data:

Your Name:
Your Company's Name:
Street Address:
City:
State: (Must be Florida)
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again (for accuracy):
Phone:
Fax (optional):
 


Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type NONE)
 
List Claims & Amounts Paid
(If none, type NONE)
 
Years In Business:
 
Business type:
(proprietorship, corporation, etc.)
 
FEIN or Social Security #:
(now required by all comp carriers to quote)
 


 
Underwriting Information:
 
Describe IN DETAIL,
Your Business Operations:
 
Payroll Class #1:
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here:
$
 
Payroll Class #2: (if none, leave blank)
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here:
$
 
Payroll Class #3: (if none, leave blank)
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here:
$
 
 
Send my quotation via: E-Mail Fax
Regular Mail

 
Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a
Workers Compensation Quote NOW!


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Thank you for visiting the insurance web site of Polo Insurance.com (An online service of Polo Insurance Agency, Inc.)
Home Office at: 12798 W. Forest Hill Blvd. Suite 205A | Wellington, FL 33414 |   Phone:  561-798-5443    |   Fax: 561-793-7586  
Privacy Notice/Copyright Info. | E-Mail: poloins@bellsouth.net   |   More About our Agency   |    2010 Insurance-Web-Sales
Questions or web site-related problems, please E-mail us at: poloins@bellsouth.net