Business Name:    
Premises Address:
City:
Florida
Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required) 
Federal Employer's ID #:
Description of Operations or SIC code:


Florida Vehicle Information:
(if more than 3 commercial vehicles please provide best time to contact)

Vehicle     Year              Make              Model             Body Type
     1        
     2        
     3        

Additional Vehicle Information:

                Miles          Cost                                          Where              Lienholder
Vehicle   Driven         New            VIN#                    Garaged              Yes/No
     1            
     2            
     3            

Florida Commercial Auto Insurance Coverage Information:

                      Liability                 Property                   Uninsured
Vehicle  Combined Limits          Damage               Combined Limits         Medical
     1                                        
     2             SAME                       SAME                       SAME                   SAME
     3             SAME                       SAME                       SAME                   SAME


                   Collision         Comprehensive
Vehicle    Deductible           Deductible
     1             
     2             
     3             

Florida Driver Information:

                                  Drivers                          Date of                                              Drivers
Driver                       Name                               Birth                  Gender                 License #
     1                         
     2                         
     3                         

Is each employee's driving record accident & violation free during the past 5 years?
Driver
     1         If No, how many accidents?    How many violations? 
     2         If No, how many accidents?    How many violations? 
     3         If No, how many accidents?    How many violations? 

Was any employee's driver's license suspended during the past 5 years?
Driver
     1      
     2      
     3      

Recent Insurance Information:

Current Insurance Company: 
Expiration Date: (mm/dd/yyyy)
Any losses past 3 years:
Description of losses, including amount paid on each accident:


Additional Information or Comments



Click on the "Submit Quote Request" button below to send your
Florida Commercial Auto Insurance quote request.**


**Information received from this Florida Commercial Auto Insurance quote request form
sent to Optimal Insurance Group will be for our use only and will not be sold, given
to, or distributed to any other parties. A quote will be based on the Florida commercial auto
insurance 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 your business to a Florida Commercial Auto
Insurance policy. We are licensed in Florida and will not provide commercial auto
insurance quotes for other states.


Florida Commercial
Auto Insurance Quote
We provide
comprehensive Florida
Commercial Auto
Insurance coverage
services in south Florida
and throughout the
Sunshine State!
Optimal Insurance Group of
Boca Raton, FL offers
comprehensive commercial
insurance coverage options and
affordable business insurance
services throughout Florida.
Contact us about Florida
Group Health, Commercial
Auto, Commercial Property,
General Liability, and Business
Owners Insurance at (561)
342-1695.
In addition to Florida
Commercial Auto Insurance
quotes, we also offer affordable
Commercial Property Insurance
policy quotes.
We are an independent Boca Raton, Florida insurance agency offering
affordable commercial auto insurance quotes to mid-sized, large, and small
businesses in the following towns, cities and counties in south Florida:
Boynton Beach, Gulf Stream, Delray Beach, Lantana, Rainbow Lakes,
Atlantis, Lake Worth, South Palm Beach, Palm Springs, Greenacres,
Wellington, Haverhill, Palm Beach, Golden Lakes, Riviera Beach, Glen
Ridge, West Palm Beach, Lake Park, Royal Palm Beach, Jupiter, Coral
Springs, Fort Lauderdale, Parkland, Coconut Creek, Margate, North
Lauderdale, Lighthouse Point, Hillsboro Beach, Deerfield Beach, The
Hamptons, Highland Beach, Weston, Plantation, Playland Isles, Melrose
Park, Lauderhill, Sunrise, Tamarac, Wilton Manors, Oakland Park,
Lauderdale Lakes, Sea Ranch Lakes, Villages of Oriole, Pompano Beach,
Lauderdale-by-the-Sea, Boca West, Boca Pointe, Juno Beach, North Palm
Beach, Loxahatchee, Belle Glade, Palm Beach Shores, South Miami,
Cutler Ridge, Princeton, Perrine, Naranja, Homestead, Florida City, Leisure
City, Richmond Heights, Pinecrest, Howard, Coral Way Village,
Westchester, Westwood Lakes, Brownsville, Sweetwater, Key Biscayne,
North Bay Village, Miami Beach, Miami Springs, Virginia Gardens, Hialeah,
El Portal, Miami Shores, Medley, Indian Creek, Surfside, Bal Harbour, North
Miami, Biscayne Park, Pinewood Park, Opa Locka, Bunche Park, Hialeah
Gardens, Palm Springs North, Carol City, Norland, Ojus, Miami Lakes,
Biscayne Gardens, Hallandale, Sunny Isles Beach, Golden Beach,
Aventura, Uleta, Miramar, Pembroke Pines, North Miami Beach, Hallandale
Beach, Ives Estates, Pembroke Park, Coral Gables, Kendall, Dania Beach,
Cooper City, Davie, West Miami, Hollywood, Broward County, Martin
County, Miami-Dade County, and Palm Beach County, FL. We can also
offer affordable Florida commercial auto insurance policy quotes throughout
the Sunshine state, including in Winter Haven, Lakeland, Miami, Orlando,
Tampa, St. Petersburg, Tallahassee, and Jacksonville, FL.
Florida Business Information:
Your Florida Commercial
Auto Insurance Source
Optimal Insurance Group
4800 North Federal Hwy
Suite D-100
Boca Raton, Florida 33431
Palm Beach County FL
(561) 342-1695
Fax: 866-314-4026
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Florida Since 2002!
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