Workers Compensation
Call or Submit the Below Quick Form
770-974-0670 Office 9am to 5pm
- Multiple Carriers Will Compete
- We'll Contact Same Business Day
- DWard Insurance since 1988
Our Highly Rated Insurance Carriers:
Hartford * Auto Owners * Travelers * Safeco * Progressive * Utica * Main Street *
American Strategic * United States Liability * Mercury * AmTrust North America *
| WORKERS COMPENSATION QUOTE FORM |
Required
|
|
Required
|
|
| Note: All questions hereafter pertain to the policyowner. |
| The Quote Form is our preliminary process of obtaining the necessary underwriting information. Be as thorough as possible. The current policy and claim history will also be required as part of the underwriting process. |
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
Required
|
|
| PLEASE LET US KNOW |
Required
|
|
Optional
|
|
| SIGNATURE REQUIRED |
| I have provided all of the above information for insurance purposes and I state all information is true to the best of my knowledge. I also understand that I am to discuss with the agent at D. Ward Insurance my desired limits and coverage. |
Required
|
|
| ADDITIONAL INFORMATION NEEDED |
| Please note - if the Business is insured, a copy of the policy and claim history will be required. They can be obtained from your current agent by requesting the documents to be sent electronically to you. |
| Thank you for time and we will be in touch with you today unless this is after hours or on the weekend - Debbie Ward and Valerie Moore |
| ENTER VALIDATION CODE |
| For Security of your personal information, enter code and press submit |
Submission Validation Required |
|
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 contact us.
Per the terms of our online privacy policy we will not resell your information to any third-party.
|