Accurate & Affordable Insurance Services


License # 0G00787

Welcome to Accurate & Affordable Insurance Services. We look forward to serving you
Thank you for your interest in our business insurance services. Accurate & Affordable Insurance will use the information you provide here for the sole purpose of getting you the most accurate quote possible.
Name of Business:
Contact Name:
Street Address
Phone Number:
Fax Number:
Email Address:
Legal Entity:
Please describe the nature of your business:
Number of employee's
Year business started: (YYYY)
Number of Vehicles:
Profit or non-profit
Years of Experience of Owner:
Are you currently insured for Commercial Auto? Yes
If yes, who is your current carrier?:
Expiration Date (DD/MM/YYYY):
Current Premium:
Number of claims in the last 3 years:
Please Enter Driver(s) Information:
Please Enter Vehicle(s) Information:
Please provide a brief description of your vehicle(s) usage:
Zip Code where vehicle(s) are parked:
Average Daily Milage of vehicle(s)
When do you need coverage to start? (DD/MM/YYYY)
Type of Insurance:
Policy Deductable
Privacy Notice: By clicking on the "Submit Form" button, you are giving Accurate & Affordable Insurance Services permission to use this information solely for the purpose of providing you with quotes. We will never sell, give, or in any way transfer your personal information to any person or entity other than the insurance carriers that Accurate & Affordable Insurance Services works with. In some cases insurance companies we work with may request a credit score

Accurate & Affordable Insurance Services, Inc.
PO Box 8247
Fountain Valley, CA 92728
Phone (714) 943-2103, Fax (888) 908-7001

Copyright 2008 Accurate & Affordable Insurance Services. All Rights Reserved