Worker Compensition Insurance

There are many different types of business insurance. With this one request form you can quote up to 14 different types of business insurance. The most Common Forms of Business insurance include General Liability, Professional Liability, Workers Compensation Insurance, and Group Health Insurance. There are also many specialty types of insurance and employee benefits and these are also listed below. Let MostChoice handle all your business insurance shopping needs in one place with one simple form and make getting the business insurance you need quick, easy, and affordable.

Pay less for your Business Insurance. Complete the following short form. It's OK to estimate some values if you are not sure, but providing correct information will allow your quotes to be processed faster and more accurately.
What most closely matches your business industry?
Brief description of the nature of the business:	(Ex: We install custom cabinets)
Year or time frame business started (OK to estimate):
What is your business legal entity?
Annual revenue (OK to estimate):
Gross annual payroll (OK to estimate):
Do you have employees in other states:	No Yes
If so, please list states:
Years of Owner Experience within Industry (OK to estimate):
Employee Information: (Note: For group health insurance, under HIPAA, only full-time employees and owners are elligible for group health insurance benefits.)
Number of Owners (OK to estimate):
Number of full-time employees (OK to estimate):
Number of part-time employees (OK to estimate):
Number of sub-contractors (OK to estimate):

Insurance Types to Quote: (check all that apply)

General Liability Protects the assets of a business in case of a lawsuit related to injury or property damage.

Have you had general liability insurance within the last 30 days? * No Yes

Name of Insurance Company:
Expiration date:
Current annual cost? (OK to estimate)
Approximate amount of claims in past 5 years:

Professional Liability / Errors & Ommissions Protects the assets of a business in case of a lawsuit related to errors, or the failure to perform work as promised, as well as other liabilities related to professional work.

Have you had professional liability insurance within the last 30 days? * No Yes

Name of Insurance Company:
Expiration date:
Current annual cost? (OK to estimate)
Approximate amount of claims in past 5 years:

Workers Compensation Protects employers from lawsuits resulting from workplace accidents. Also provides medical care and lost income compensation to employees injured on the job.

Have you had workers compensation insurance within the last 30 days? * No Yes

Name of Insurance Company:
Expiration date:
Current annual cost? (OK to estimate)
Approximate amount of claims in past 5 years:
NCCI experience modification factor, if known:

Group Health Provides health benefits to a business's employees.

Business Auto Provides coverage for business-use vehicles. Can range from one car to an entire fleet.

Commercial Property Policy Protects the business property which is owned by the business.

Business Owners Policy (BOP) Combines general liability and business property coverage into a single policy.

Garage Insurance A combination Business Auto Coverage and Commercial General Liability A typical garage business has an auto exposure (owned, non-owned and hired) as well as premises/operations, contractual and products completed operations exposures. Rather than writing two separate policies, the Garage policy allows you to combine the coverages into one form.

Garage Liability Insurance Covers Garage Operations other Than Covered "Autos" (CGL exposures) and Garage Operations Covered "Autos" (Auto exposure) for bodily injury and property damage. It also covers pollution cost or expense for auto exposure only.

Garage Keepers Legal Liability Coverage Garage Keeper's Legal Liability coverage is for businesses who offer towing services or operate service stations. It provides protection for customer's vehicles that are being kept under covered location for parking, storing, or performing service.Garage Keeper's Legal Liability insurance provides protection in case a vehicle is damaged by fire, theft, vandalism or collision.

Business Interruption Insurance protects a business owner against losses resulting from a temporary shutdown because of fire or other insured peril. Generally, business interruption insurance provides reimbursement for lost net profits and necessary continuing expenses.

Directors and Officers Liability Insurance Coverss the directors or officers of a company if they are sued as individuals. Coverage is also provided for the costs of defense such as legal fees and other court costs.

Have you had directors and officers liability insurance within the last 30 days? * No Yes

Name of Insurance Company:
Expiration date:
Current annual cost? (OK to estimate)
Approximate amount of claims in past 5 years:

Crime Insurance Provides coverage for the perils of burglary, theft, and robbery.

Bonds There are two types of bonds, a Surety Bond Guarantees compliance with local laws and fulfillment of contractual obligations. A Fidelity bond protects a business for losses related to fraudulent employee acts.

When do you need coverage to start?

Contact Information: Finish for Quotes. Your information is kept safe and secure and will only be used to provide quotes.
* First Name:
* Last Name:
* Business Name:
* Address:
* City:
* State/Province:
* Zip Code:
* Primary Phone: (include area code)	ext.
Alternate Phone: (include area code)	ext.
Fax: (include area code)
Email:

By clicking "Get My Quotes" and seeking a quote request I authorize and agree that up to four insurance companies or their agents and partner companies may contact me using this information or to obtain additional information needed to provide quotes where permitted by law. I acknowledge that I have read and understand all of the Terms and Conditions of this website and agree to be bound by them.

Medical Plans to Quote - (select at least one)
	(MMP) Major Medical Plan - This plan is favored by those who prefer to choose any doctor or hospital. This is typically the most expensive medical program.
	(PPO) Preferred Provider Organization - This plan generally affords you the ability to choose any doctor or hospital from the PPO's directory or to use a doctor outside the plan, at a higher expense.
	(POS) Point Of Service - This plan typically has a network, but allows for self and physician referrals to be covered regardless of network status.
	(HMO) Health Maintenance Organization - Often the most affordable plan, it strictly regulates access to doctors and hospitals to a specific network.
Optional Coverages/Benefits - (select any that you are interested in)
	Dental Coverage - Inexpensive coverage to assist in the cost of cleaning and maintaining teeth.
	Maternity Coverage - Covers Maternity under the same benefits as an illness.
	Prescription Benefit - Covers Prescription Drugs with a co-payment.
	Vision Care Benefit - Covers some costs associated with vision care and correction.
	Life Insurance - Provides additional life insurance protection.
	Disability Insurance - Provides disability insurance protection, long term and short term available.
	401K - A retirement option that is not related to Health Insurance, but often installed at the same time of a health insurance plan or open enrollment.

Do you lease or own your property?	Lease Own Other
Property type:
If property type selected above is other, describe:
Construction type:
Total square footage of buildings, if applicable:
Total square footage of your space, if applicable:
Approximate year(s) building(s) constructed, if applicable:
Building features: (check all that apply)
Sprinkler system Smoke detectors Burglary alarm Security guard Fire alarm	Exterior lighting Barred windows Circuit breakers Fuses
Approximate amount of liability coverage needed:	$

Worker Compensition Insurance

Pay less for your Business Insurance. Complete the following short form.