4615 10TH Ave N
Lake Worth, FL 33463
Phone: 561-965-0700
400 Village Blvd.
West Palm Beach, Fl 33409
Phone: 561-686-5700

Request A Quote

A Affordable Auto Assurance offers three convenient ways for you to receive free auto insurance quotes. You can either:

Complete the form below and a representative will contact you.
Click here and print a copy of the quote form and fax a completed copy to 561-965-7677
Call us at 561-965-0700 or 561-686-5700.

Name:
Phone:
Drivers:
Vehicles:
Zip Code:

Driver Information

Date of Birth:
Sex:
Married or Single:
Accidents:
Violations:
Suspensions:

Vehicle Information

Year of Vehicle:
Make of Vehicle:
Model of Vehicle:

Insurance Information

Please select the type of coverage you are interested in

State Required (PIP/PD)
Bodily Injury Liability (BI/PIP/PD)
Basic Full Coverage (PIP/PD/Comprehensive and Collision)
Full Coverage (BI/PIP/PD Comprehensive and Collision/Rental/Towing)

(Type in limits of bodily injury liability, property damage liability limits, and uninsured motorist coverage)

Discount Information

Prior Insurance Information: (Include company name and dates of coverage)

Current Insurance Company Name:

Coverage Expiration Date:

Are you a current homeowner?

For Student Discount – Are you a current high school student with a grade point average of 3.0 or higher?

Locations

Choose a location nearest to you:

4615 10TH Ave N, Lake Worth, FL 33463
400 Village Blvd. – West Palm Beach, Fl 33409

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