Please note that this form is for a REQUEST ONLY. By submitting this form it does not bind coverage in any way. If you do not hear from us in a reasonable amount of time, ASSUME WE DID NOT GET THIS REQUEST FOR AN INSURANCE QUOTE, and call our office.
I understand that filling out and submitting this form DOES NOT bind coverage in any way, and the only way coverage can be bound will be when I am informed of a binder or policy is issued by the agent representing me. Please note that coverage cannot be bound or changed by using the Internet or Email.
Before submitting this form, please click on the link below to move the contents of box "A" into box "B" leaving the first box empty.
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Gifford-Heiden Insurance Agency
111 East Venice Avenue
Venice, Florida 34285
Phone: (941) 484-0681
Fax: (941) 485-3835
Office Hours: Mon-Fri 8:30am-5:00pm