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Workers Compensation Quote


    If more than 1 owner or officer is to be excluded, list each name, title and date of birth in the comment section below.
    Do you want to exclude the owners from coverage? If YES, We will not count their payroll in calculating premiums.
    We are unable to offer a work comp quote without your Employer Identification Number (EIN) or if you are operating as an individual and do not have an EIN, enter your social security number as the EIN.
    If Known enter class code
    If Known enter class code
    If Known enter class code
    Enter annual payroll for class code 1
    Enter annual payroll for class code 2
    Enter annual payroll for class code 3
    Enter name of your prior insurance company and expiration date if previously insurance
    Max file size: 20MB
    You can upload prior declaration page or loss runs from your previous company here.
Submit

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