Request a Workers' Compensation Insurance Quote

Fill out the following form, making sure to enter the company's details as accurately as possible. Once you have completed the form, click the Submit button to send your information (a confirmation page will follow). Your request will be handled promptly.

Company Name *

Mailing Address, City, State *

ZIP / Postal Code *

Nature of Business *

# of Locations *

# of Employees *

Annual Payroll Estimate ($)

YOUR CONTACT INFORMATION

First Name *

Last Name *

Primary Phone Number *

Alternate Phone Number

E-Mail Address *

Do you currently have insurance?

Current Insurance Provider

Remarks/Additional Information

Submission Validation

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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to call us at (218) 722-1481 or (877) 874-1000 toll free.

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202 W. Superior Street, Suite 400
Duluth, MN 55802
(218) 722-1481