Personal Details
Step 1 01/8

Welcome! Enter your personal details to start.

Business Details
Step 2 02/8

Please enter your business name and address

Tell us your legal company name unless you are a sole proprietor, then your first and last name will replace your business legal name. No PO Box numbers please. Speed tip: If you enter your street address and zip code, we will populate the rest!

Business Details
Step 3 03/8

Tell us what type of business entity you have

Business Details
Step 4 04/8

What year did you start your business?

When you look at the division of corporations, this would be the year from “the event date filed or event effective date”

Business Details
Step 5 05/8

How Many Employees do you have?

Do you want to be included in the policy as an owner?

Please estimate your subcontractors payroll

Include 1099 workers' payroll. Do not include owners payroll.
Work Detail
Step 6 06/8

What type of work do your employees do?

Each workers comp class code will give you the ability to add any included owners, W2 employees and 1099 workers that do not have their own WC policies and need to be covered. Keep in mind that in order to be covered under the policy, all employees will need to be paid as W2.

Please select code to continue

Whats Your Number of Employees and Weekly Payroll For These Activities?

What is your number or employees and expected payroll for the selected activities on a weekly basis? Include owners, and all W-2 employees. Also include all subcontractors, cash and 1099 workers who haven't provided proof of their own workers compensation coverage.

About Your Work
Step 7 07/8

Do you or have you had workers comp under this entity before?

Select yes or no on if you have had workers comp coverage under this entity currently or in the past

Is your current workers comp active?

Has your workers comp policy ever been revoked, or canceled in the last 3 years?

Have you had any claims or accidents in the last 3 years?

What was the estimated cost of the claim?

Have you had an accident in the last 12 months?

About Your Work
Step 8 08/8

Are you employees subject to working high above ground or below ground?

For "Above ground", if you are working in the interior it does not count, please select only if your workers are 15 feet or above on exterior.

What is the maximum exterior height exposure your workers have (in floors)?

building

How do your employees reach these heights?

What is the max depth exposure you have (in feet)?

dig

Congratulations!

Personal Name Email Phone
Business Details Business Name Address
Business Details Business Ownership Structure
Business Details Founded in Year
Work Detail Employees
Work Codes Detail
About Your Work Workers Comp Accident Last Year Active Comp Policy Revoked Claims & Accidents Claims Cost
Height/Depth Exposure Employees subject to working Max Height Exposure Employees reach these heights Max Depth Exposure

Thanks!

Thanks for completing your quote!

You will be receiving shortly in your email a link to be able to review the detailed quote, e-sign documentation and complete payment.

Thanks!

Thanks for completing your quote!

We will contact you shortly with options for your insurance.
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Insurance starting at $8.00/week
per employee

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Your Information
Name
Email
Phone
Business Name
Business Add.
Business Ownership Structure
Founded in Year
Employees
Owner Included
Work
Weekly Payroll
Workers Comp
Accident Last Year
Active Comp
Policy Revoked
Claims & Accidents
Claims Cost
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