As heard on 850 WFTL


SR-22 QUOTE FORM

  INFORMATION
Name:
Email:
Phone:
Best Contact Time:
Date of Birth:
Mailing Address:
City:
Zip Code:
  VEHICLE
Year:
Make:
Model:
Garaging Zip Code:
VIN #:
Primary Use:    Pleasure:          Business:  
Anti-lock Brakes:    Yes:          No:  
Anti Theft:    Yes:          No:  
  ADDITIONAL VEHICLE (If applicable)
Year:
Make:
Model:
Garaging Zip Code:
Primary Use:    Pleasure:          Business:  
Anti-lock Brakes:    Yes:          No:  
Anti Theft:    Yes:          No:  
  PRIOR INSURANCE
Number of years with your most recent auto insurance carrier?
Primary Residence:
Would you be interested in a "paperless email" discount?
Yes:          No:  
  CHOOSE YOUR COVERAGE
Bodily Injury - Property Damage:
Uninsured Motorist:
Medical Payments:
PIP Deductable:
Comprehensive Deductable:
Collision Deductable:
Rental:
Roadside:    Yes:          No:  
Any vioations in the past 35 months?
Yes:          No:  
If yes, list violations:
Drivers License #:
SR-22 Case #:




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Myers Insurance Agency, Inc. has been serving the entire state of Florida and our surrounding cities including Pompano Beach, Margate, Lighthouse Point, Deerfield Beach, Boca Raton, Fort Lauderdale and Coconut Creek since 1981. We offer Automobile, Commercial Auto, Motorcycle, Marine, Personal Watercraft, Recreational Vehicle, Health/Dental/Vision, Life, Homeowners, Business Liability and SR22/DUI/FR44 insurance. We are available in our office Monday thru Friday from 9am. to 5 pm., Saturday from 9am. to 4pm. and Sunday by appointment. Please stop in or call us at 800.336.9377.

DISCLAIMER: Your insurance policy, and not the information contained on this website, forms the contract between you and your insurance company. The policy contains limits, exclusions and limitations that are not detailed on this website. If there is a discrepancy between information contained herin and your policy, your policy takes precedence. There is no intentionally misleading information contained in this website, however, DUIFR44.com takes no responsibility for errors. We will endeavor to correct or clarify any incorrect information.

PRIVACY STATEMENT: DUIFR44.com does not sell, trade or rent your personal information to outside companies. Any information you provide is held strictly confidential and is used only for the handling of your business with and through DUIFR44.com.

INSURANCE COVERAGES:

  DUI/FR44
  SR22
  Non-Owners
Myers Insurance Agency, Inc.
703 S. Federal Highway
Pompano Beach, Fl.   33062

Phone:
  800.336.9377
Fax:
  888.784.9076
EMAIL:

  info@duifr44.com
  webmaster@duifr44.com