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Workers' comp quote

Required: name and phone. The more you fill in, the faster your quote. Skip anything you don't know.

Your information

Full name *Business name *Phone *EmailMailing address

Business & employees

Tax ID / FEINDescription of work / class codesNumber of employees by job type (e.g. 3 cooks, 2 cashiers)Annual payroll by class / job typeDo you use subcontractors? (annual cost, do they carry their own WC?)Owners / officers

History

Prior workers' comp carrierExperience mod (if known)Current policy expiration dateClaims in the past 3 years

Your current coverage Upload current coverage / declarations page (optional, PDF or photo, up to 10 MB)

Or email it to [email protected].

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Hachem Insurance Agency

313-828-2266 · [email protected]

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