DirectWorkComp

Please enter insured contact information

Insured Email

Insured Phone Number

The customer information is for carrier use only and no quote correspondence will go direct to the insured

By clicking 'Next', you permit Directworkcomp or our partners to contact you at the provided phone number (includes prerecorded, automated and SMS methods), even if you are on a 'Do Not Call' registry. You are not required to consent in order to use our services.

By clicking start, you agree to our terms.

How many years has the business been in operation?

Business Name & FEIN/SSN

What is the legal structure of your business?

Corporation

Partnership

Limited Liability Company

Sole Proprietorship

Other

Location

Where is your primary business located? You can add more locations later

Tell us how many employees your business has including full-time, part-time, and owners/officers

What is the primary type of work your business does?

Add

Add Another Location

Do you want to include owners/officers?

Yes