 |
|
What is your experience modification percentage? If any. |
|
What classifications (4 digit) are used and what is estimated annual payroll for these classifications? Classification
Annual Payroll
|
|
What is your e-mail address ? |
|
Please fax 2 or 3 months or quarters of your last billing statements from your workman's comp carrier. |
|
Who is your current work comp carrier? |
|
If you do not have prior insurance, how many years of experience do you have |
|
What is your federal I D number? |
|
What is your contractor license number? |
|
Comments |
|
|
Your protection and security are our primary concern. CONTRACTORS INSURANCE SPECIALISTS |
|