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Let's get to know your company! 
We recognize that data collection may not be the most thrilling task, but it's crucial for crafting a personalized proposal that fits your needs perfectly! So, let's jump right in and kickstart the process!

Completing this form should take approximately 45 minutes, and you can save your progress and come back to it whenever you like. The form is divided into three sections for your convenience.
  • Section 1: Company Profile - 15 minutes 
  • Section 2: Workers Compensation Review - 15 minutes
  • Section 3: Benefits Review - 15 minutes

Who is completing this form?




Section 1: Company Profile

Organization Detail











If completing on your computer, press ctrl/command and select each state that applies






Number Of Employees



Primary Contact




Payroll



Benefits

Software Utilization 
Are you currently using or are you interested in using any of the following products?



Current Challenges


Document Upload

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Underwriting Options 


Section 2: Workers Compensation Review

Current Policy Review







Company Detail Questions






























Section 3: Benefits Review

Health Policy Review












Ancillary Benefits Review




401(k) Policy Review




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