Workers Compensation Quote Request
For Restaurants, Bar, and Tavers
Company Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
Phone Number
-
Area Code
Phone Number
E-mail
Business Description
Describe operations, hours of operations, etc.
Years in Business
Years Experience
Prior / Currently Insured
Yes
No
Expiration Date
-
Month
-
Day
Year
Date Picker Icon
Check all that apply
Prior Claims
Open after 2 AM
Delivery
Live Entertaiment
Dance Floor
No Prior Insurance
Number of Employees (full & Part Time)
Number of Locations
Total Annual Payroll (Excluding Clerical)
Include owners if Not Exempt
Clerical Payroll
Include owners if Not Exempt
Submit
Should be Empty: