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6
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1
Name
Company Description
First Name
Last Name
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2
Email
example@example.com
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3
Phone Number
Area Code
Phone Number
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4
How many employees
Please provide the number of employees, fulltime, part time, along with a high level description of their duties
How many Clerical positions
Please Select
Workers Comp
General Liability
Commerical Auto
other
Workers Comp
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Workers Comp
General Liability
Commerical Auto
other
Insurance type
Home Many owners with 15% or more ownership.
Number of other employees
How many Independent contractors
Annual Payroll
Annual Premium Paid
Description of other employees, (eg . roofers)
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5
Upload your payroll journals, insurance policies, premium statements, letters from Carrier about audit
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6
Number
Estimated Savings Range
We can save or reduce errors resulting in a 20 to 30 % saving of the Annual premium!
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7
Tags
Todo
In Progress
Done
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