Workers Compensation Step 1 of 5 20% NameEmail Phone Business NameBusiness Address Description of Operation(s)How many years are you in business under this name?How many years of experience do you have in this industry?Did you have any worker’s compensation claims with ANY insurance companies within the last 3 years?YesNoHow many claims123+ Do you have a business location or a home office?Business LocationHome OfficeDo you rent or own this location?RentOwn What is the total estimated annual payroll?Total number of employees working for you?Total ## of Males# of Females List of Employee Positions, Descriptions of Duties, # of Employees in this position, payroll per employeeEmployee PositionsDescriptions of Duties# of Employees in this positionpayroll per employee
