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Office: 810-648-5400

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Office: 810-359-7000

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Office: 810-721-1300

Sheridan Agency Workers
Compensation Quote Form
It only takes a few minutes!
Referred By:
Choose the Sheridan location
nearest you: (Required)

Your Personal Data
First & Last Name: (Required)
Your Company's Name:
Street Address:
City:
State:
Zip Code:
E-Mail (required):
E-Mail (re enter):
Phone:
Fax:

Currently Insured?:
If yes, list carrier, and
number of years continuous.
Type of Business:
List Claims & Amounts Paid
or type None
Years In Business:
Business Type:
(proprietorship, corporation, etc.)

UNDERWRITING INFORMATION
Describe Business Operations in Detail:


Payroll Class #1:
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this class:


Payroll Class #2: (If none, leave blank)
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this class:


Payroll Class #3: (If none, leave blank)
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this class:

Comments or Questions:
Send my Workers Compensation 
Quote by:
We treat all your responses as private information. We will not give your data to any other person or group for any purpose. Although it is our intent to keep your information private, we cannot guarantee that it will not be viewed by others accidentally. Our online quote forms are to provide current and prospective clients an estimated premium only. No coverage can be bound by this process until original applications, signatures and premium are received and submitted to the insurance company for underwriting.

If you agree, please select YES and click the Submit button so that we can get to work on getting you your quote.
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