Logo.gif (11507 bytes)    166 Winthrop Ave. Revere MA 02151 781-284-8783, fax 781-289-4451

Lattanzi Insurance Agency is licensed to sell insurance in the state of Massachusetts.   If you are not a resident of Massachusetts, or if the exposure you wish to insure is not in the state, we will be unable to provide you a quote.  Quotes provided from this form are estimates only.  These quotes are subject to change upon formal application and additional information obtained or revised.  Lattanzi Insurance Agency accepts no responsibility for electronic piracy, etc., when any information is submitted electronically.  Completing and submitting the following information indicates understanding and acceptance of these terms and conditions.  Submission of application information does not obligate you to purchase any product or insurance, nor does it represent any agreement to provide coverage under any insurance policy.

Health Insurance Quote Form

wpe6.gif (2088 bytes) for a quick comparison quote, fax your current policy to
(781) 289-4451or email Peter@Lattanziinsurance.com

Please provide the following contact information:

Company name
Address
City
State (Mass. Only) Zip
Contact person
Work phone
Fax
Email

Please provide the following company information:

Full description of Business

How long in business

Type of health insurance interested in:

Currently insured

Once the above information is received, our agency will contact you to discuss your insurance needs.

Please list any questions or concerns.