Return to Polo Insurance Agency Main Page Polo Insurance.com Home Page    | Welcome to the Website of Polo Insurance Agency, Inc.
Free Online Florida auto, home, contractor and business Insurance Quotes from Polo Insurance Agency
Auto Insurance Motorcycle Ins. Homeowners Insurance Renter's Ins. Workers Comp Contractor Liability Businessowners
FAST & FREE Florida Insurance Quotes
Polo Insurance Agency saves you money on  your Florida personal and business insurance!
Free Quotes & Services
from Polo Insurance Agency, Inc.

Online Services From Polo Insurance
Please Click on any of our Online Services below:

 
Request Policy Service

Request Insurance Certificate

Get a Map & Driving Directions to our Office

Find Out More About our Agency & Services

E-Mail us with Questions or Comments

Read Our Privacy Notice

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 Dental Insurance
Quotation Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data

Your Name:
Street Address:
City:
State: (Must be Florida)
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 
Marital Status:
Single Married
Do You Own Your
Own Business?

Yes No
 
Dental Ins. Currently?
(If yes, list carrier, and # of years
continuous. If none, type N/C)


UNDERWRITING INFORMATION
 
Insured Name: Birthdate:
Insured Height: Insured Weight:
Insured Occupation: Hazardous Activities? (if yes, describe):
Sex (M/F): List children's
ages to be covered
Be as specific as you can on the underwriting questions below so we may find the most competitive product for you!
Any Pre-existing Dental Conditions?
(If yes, descibe in detail, and to which of the insured persons they apply.)
 
Any Covered Persons Have Specific Dental Insurance Needs?
(If yes, descibe in detail, and to which of the insured persons they apply.)


COVERAGE INFORMATION
 
How Long Do You Want Policy For?
(i.e., monthly, quarterly, 6 month, etc.)
 
What Deductible or Coverage Do You Want?
($250 ded., 80% Coverage, etc.):
 
Any special coverages needed?
(Othodontist Coverage, etc.)
 
Tell Us What You Want MOST in your Dental Plan, or list any other Remarks here:


Send my quotation via: E-Mail Fax
Regular Mail
Call me by Phone!

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 My
Dental Insurance Quote NOW!


Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!

 
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