WORKERS COMPENSATION QUOTATION REQUEST

Company Name or Individual Name:

Office Address:

Phone Number:

Contact Person:

Are You A Corporation?

Yes  No
   

List Gross Payroll Information Below For Quoting:

 
Clerical Employees:

** Members of Corporation:

***Sole Proprietors or LLC Members:

   

**Please note, all Corporate Officers must be included by law. Minimum salary requirements for Corporate Officers is $20,800 and the maximum salary requirement allowed is $83,720 for the year 2002. (In New Jersey)

***Sole Proprietors and members of LLC’s can elect or reject to be covered for Workers Compensation. List payroll information if coverage is requested. The minimum and maximum salary as listed for Corporate Officers will apply.

Please note the insurance carrier audits all workers compensation policies at the end of each policy year.

 

  

One Indian Road · Denville · NJ  07834 

800-347-3417

 

     

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