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Online Contractor General Liability Quote Form One Simple Form - takes only 2-3 Minutes!
Your Name:
BUSINESS Name:
Mailing Address:
City:
State:
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):

Business Underwriting Information
Type of operation:
Describe operations in detail:
License class:
License Number:
Social Sec. or Employer ID#:

Limit of Liability Coverage Requested?	$300,000 $500,000 $1 Million

Currently Insured?	Yes No
Name of Carrier & how long insured?
Prior Claims?	Yes No
Describe claims in detail:

Years in business:
Years experience in field:
Percentage of work residential:
Percentage of work commercial:

Number of Active Owners:
Number of Employees:	0 1 2 3+
Annual Employee Payroll: $
Annual Gross Sales: $

Do you subcontract work?	Yes No
(If yes, what percentage of your work is subbed, and what kind of work?)
Do you do foundation work?	Yes No
Do you work on condos?	Yes No
Employees paid over $18/hour?	Yes No
Do you have a safety program?	Yes No

Comments/Remarks:

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The Workers Comp Pro.com has made purchasing workers compensation insurance EASY and PAINLESS! Our site will enable you to compare and purchase your insurance with over 50 carriers, providing YOU with the best value for your insurance anywhere! Get a FREE QUOTE on your insurance today and see the savings.

We currently write insurance in the states of Virginia, North Carolina, South Carolina, Georgia, Tennessee, Florida, and the District of Columbia. We look forward to serving you and helping you find the best insurance available.