Workers Comp Sample

Workers Compensation Insurance Leadid:  12344

Workers Compensation Insurance

When does your workers compensation insurance expire?:  Less than 1 month

Do you use heavy machinery on the job?:  No

How many years have you been in business?:  More than 2 year

How many years have you been in business?:  2-3 years

How many full time employees would you like to insure including owners and partners?:  8

What industry is your business in?:  Office

How many active Owners/Partners?:  1

Customer Information

Full Name:  Johnson ********

Your Comapny Name:  **************

Address:  **** Adison st

City:  Sunnydale

State:  AZ

Zip:  35221

Email Address:  ********@gmail.com

Primary Phone:  ***-***-3456

Secondary Phone:  ***-***-4433

Best Time To Contact:  Morning