We do the shopping for You!  We compare companies and then help you get the coverage in place if you want it.

Read This BEFORE you proceed:
Due to our ability to be extremely competitive when we package policies, we can no longer quote workers compensation insurance if that is the only insurance quote request we receive.  In order for us to write your workers compensation insurance, we must have supporting coverage in the form of commercial liability and possibly others.  Give us a call at 1-800-243-6296 if you have questions or wish to speak with a live person.
Please complete the following information.
Of course, no coverage is bound and any quote is subject to inspection and other underwriting criteria.  All information is totally confidential!  We do not sell names to any organization for any use.
Is your business in the state of Arizona, Indiana or Michigan?  If not-- get out. Quotes currently only for Arizona, Michigan and Indiana. Stay tuned for more states!

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Your Company's Full Name:   
Type of Entity:   Individual    Partnership    Corporation    Other
Your Name as Contact:
Your email address:           
Your phone number:           
Your street address:
Your city:                          
Your State:                        
Your zip code:                   
County (not Country):    
How many years has THIS company been in business?
How many years experience has the owner had in this TYPE of business?
Describe your business.  What products or services do you perform?
How many owners and/or officers are there?
How many OTHER employees are there?    
What is the estimated annual payroll per year (not including owners/officers)
Describe the each employee class's duties and estimated annual payroll for each:

Currently Insured? Yes           No

If yes to currently insured, please answer the following:

Current Insurance Company:                   
Policy Number:                                      
Annual Premium you are paying currently:
Expiration date of current policy:             
Is your current company canceling or non-renewing you?  If so, Why?

How did you find our site? 

If you chose "Other Search Engine, which one? or if you chose "Other", What?

Thank you for completing our online quote form.