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BGES Group
216 A Larchmont Acres W
Larchmont, NY 10538

New York insurance

"All Our Policies Come With
an Agent!"
  

On-Line Workers
Compensation Quote Form
One Simple Form - takes only 2-3 Minutes!
Your Personal / Company Data:

Your Name:
Your Company's Name:
Street Address:
City:
State: MUST be New York!
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again (for accuracy):
Phone:
Fax (optional):
 

Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type NONE)
 
Previous Losses: None 1-2
More than 3
 
When Does Current Coverage Expire?
 
Years In Business:
 
Current Premium Size (our programs are most competitive on policies over $10,000 per year in premium): $
 

 
Underwriting Information:
 
Describe IN DETAIL,
Your Business Operations:
 
If you know your experience
modification, list it here:
 
If you are a contractor, list
% of work subbed out here:		 %
 
Payroll Classes & Payroll Amounts:

8810 (Clerical) $
8809 (Executive Officers) $
8742 (Salespersons) $
Add'l Class Code | Add'l Class Description           (Add'l Payroll in Dollars)
$
$
$
 
 
Send my quotation via: E-Mail Fax
Regular Mail

 
Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a
Workers Compensation Quote NOW!

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New York contractor insurance