Unemployment Quote Submittal

Unemployment Quote Submittal
Member Name (SU/SD):*
Applicant Name:*
Applicant Title:*
Applicant Phone #:*
Please enter a valid phone number
Applicant Email:*
example@example.com
There are two components needed to obtain a quote.

Please forward any additional documentation (if available).
Estimated taxable wages for the year you wish to join.*
This is defined as the first $8,000 in wages per employee (not FTE).
Do you have three complete fiscal years as well as the current year claims activity from the Vermont Department of Labor?*

YesNo
Please upload the information here.*

Cancelof
Date*

MonthDayYear
Date
Should be Empty: