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excellent decision

if you don't have these handy, just skip for now

  • enter your contact information
  • enter the business information
  • Upload loss Runs

Contact info

Full Name


Phone number

Business information

Legal business name

website address

Owners name's

Owners excluded from workers comp?

How many years in business?

list all locations

Employee data (estimate on wages is ok)

List annual estimated wages separated by class code

List Full time and Part time

Do you have 3-5 years of loss runs from current/previous carrier?

Upload loss runs

When would you like coverage yo start?

Current Payroll providers

Who do you use for payroll processing?

Do you use HR Services?

Do you offer health benefits?

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