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Thank you for your interest in Cove Risk’s money-saving workers’ compensation coverage.

Please supply the following information to receive your FREE, no-obligation quote.

We will contact you within 1 business day.

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Company Name*

Business Description*

Contact Name*

Address

Address 2

City

State

Zip Code*

Phone*

Email*

Do you currently have workers' comp insurance?
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Is this a new business?
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About how many employees do you have?

How many years have you been in business?

Estimated annual payroll for all employees

Current Broker

Policy expiration date

What bothers you most about your
current coverage?


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