Cluett Commercial Insurance Agency - Workers’ Comp Speed Quote

Simply complete and submit this form for a Workers' Comp SPEED QUOTE.

We represent over 50 carriers and insurance organizations and will work hard to find you great offers!

Submitting Agency Information

* Indicates required field

Agency Name *

Producer *

First

Last

City *

State *

Email *

Office Phone Number *

Cell Phone Number *

Insured Information

Company Name *

State *

FEIN *

Zip Code *

Coverage Information

Current Carrier *

Expiring Annual Premium *

Effective Date *

Upload Documents
Please Upload the following information that is Required * to Quote.

Acord 130 *

Only one file per upload allowed. Maximum file size: 20MB

Loss Runs (or Resume if new Venture) *

Only one file per upload allowed. Maximum file size: 20MB

Experience Mod Worksheet (if Experience Rated) *

Only one file per upload allowed. Maximum file size: 20MB

In a Rush? How soon do you need your SPEED QUOTE? *

When Available Within 24-Hours ASAP!

Are you Interested in? *

Pay-As-You-Go Premium Financing Monthly Self-Reporting of Payroll

Comments or Special Instructions *

Submit

Each Workers’ Compensation Program offered through Cluett varies by state, minimum premium, eligible classes, and modification factor or by loss ratio. The underwriters at Cluett review each submission to match program eligibility and provide a quote(s) when available. Please contact our Underwriting Department for questions or information on all available programs.