Workers Comp and Health Insurance Quote

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Workers Comp and Health Insurance Quote

Fill out the form below for a no risk, no obligation quote. The more information you provide us with with the quicker we will be able to provide you with a quote.In order to qualify for our programs a minimum of $50,000 of payroll must be processed. In order to qualify for the health program, you must have a minimum of 2 participants.

Name:

Company Name:

Address:

City:

State:

Zip Code:

Phone:

Tax Id #:

Estimated Annual Payroll by Workers Comp Code

(Code is 4 digit number listed on Workers Comp Dec page such as "8810 - Clerical")

Code 1

Code 2

Code 3

Code 4

State

Payroll

Workers Comp Modifier:

Benefits of Interest

Health

Dental

Life

Vision

401k

Pre-tax Cafeteria 125 Plan

Comments:

Workers Comp and Health Insurance Quote

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