Business Name:    
Premises Address:
City:  
Pennsylvania
Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required) 

About Your Pennsylvania Business:

Federal Employer's ID #:
Description of Operations or SIC code:


# of full-time employees:     # of part-time employees:
# of locations:     Estimated Annual Payroll: $
Experience Mod (if any, per policy)

Select all that apply to your Pennsylvania business:
Operate or lease aircraft/watercraft     Work Underground
Work above 15 feet                           Require out of state travel
Use Subcontractors                            Delivery Service
Pre-employment physicals                   Offer safety incentive programs
Store, treat, dispose, or transport hazardour waste
Work on vessels, docks, or bridges over water
Other

Recent Insurance Information:

Current Insurance Company: 
Policy #: Expiration Date: (mm/dd/yyyy)
Losses past 3 years:
Description of losses or loss runs:


Which insurance coverages do you currently have:
Pennsylvania Commercial Auto
Pennsylvania Commercial Liability
Pennsylvania Commercial Property
Pennsylvania Workers Comp
Pennsylvania Group Health
Pennsylvania Group Life
Pennsylvania Group Disability
Pennsylvania E & O
Other

Pennsylvania Employee Information:

Employee       Classification Code       Yearly Payroll Estimate
      1                                         $
      2                                         $
      3                                         $
      4                                         $
      5                                         $

Officers / Partners / Owners Information:

Principal             Name                                           Title                        Include
      1             
      2             
      3             

Additional Information or Comments



Click on the "Submit Quote Request" button below to send your
Pennsylvania Workers Compensation Insurance quote request.**

**Information received from this Pennsylvania Workers Compensation Insurance
quote request form sent to Lower Bucks Insurance Associates will be for our use
only and will not be sold, given to or distributed to any other parties. A quote will
will be based on the Pennsylvania workers compensation insurance information
provided and does not guarantee acceptance of the risk by us. The precise
coverage afforded is subject to meeting underwriting guidelines, and the terms,
conditions and exclusions of the policy as issued. By submitting this request
you acknowledge that this is neither an offer to insure nor a guarantee of
insurance. Completion of this form does not entitle your business to a
Pennsylvania Workers Compensation Insurance policy. We are licensed in
Pennsylvania and will not provide workers comp insurance quotes in other
states.


Pennsylvania Workers
Comp Insurance Quote
We can provide lower cost Pennsylvania Workers Comp
Insurance premiums for your Bucks County, PA small business
or for your business located anywhere in Pennsylvania!
Lower Bucks Insurance
Associates of Bristol, PA offers
comprehensive commercial
insurance coverage options and
affordable business insurance
services throughout
Pennsylvania.
Contact us about Pennsylvania
Commercial Auto, Business
Owners, Errors & Omissions,
and Workers Compensation
Insurance at (215) 788-3100.
In addition to receiving a
Pennsylvania Worker Comp
Insurance quote, we can also
offer other affordable
Pennsylvania Insurance quotes.
We are a Bristol, PA insurance agency offering lower Pennsylvania
workers comp insurance policy quotes to large and small businesses
located in the following towns, cities and counties in Pennsylvania:
Bridgewater, Croydon, Bensalem, Nottingham, Edgely, Newportville,
West Bristol, Strafford, Devon, Berwyn, Port Kennedy, Newtown Square,
Gradyville, Cheyney, Concordville, Narberth, Milltown, Westtown,
Trainer, Marcus Hook, West Chester, Lancaster, York, Reading,
Bethlehem, Pottstown, Coatesville, Kulpsville, Warminster,
Montgomeryville, Levittown, Valley Forge, Malvern, Green Tree, Paoli,
Devault, Chatwood, Goshenville, Sugartown, Glenloch, Chester Springs,
Audubon, Eagleville, Evansburg, Worcester, Blue Bell, Center Square,
Fort Washington, Doylestown, Chalfort, Quakertown, Perkasie,
Sellersville, Soudertown, Willow Grove, Warrington, Morrisville, Ambler,
Lower Gwynedd, Washington Crossing, New Hope, Richboro,
Feasterville, Southampton, Langhorne, Holland, Newtown, Yardley,
Philadelphia, Emmanus, Hellertown, Whitehall, Cetronia, East Texas,
Lanark, Dorneyville, Wagnersville, Catasauqua, Walbert, Farmersville,
Stiles, Friedensville, Mechanicsville, Hanover, North Catasauqua,
Stroudsburg, King of Prussia, Springfield, Woodlyn, Chester, Norwood,
Ridley Park, Prospect Park, Folcroft, Darby, Swarthmore, Drexel Hill,
Rutledge, Yeadon, Upper Darby, Secane, Milmont Park, Garden City,
Wallingford, Morton, Aldan, Primos, Pilgrim Gardens, Colwyn, Lester,
Essington, Eddystone, Landsdowne, Fernwood, Milbourne, Havertown,
Broomall, Penn Wynne, Merion Station, Wynnewood, Haverford, Penn
Valley, Bala-Cynwyd, Ardmore, Rosemont, Overbrook, Belmont Hills,
Villanova, Rebel Hill, Gulph Mills, Gladwyne, Conshohocken, Kings
Manor, Swedeland, Swedesburg, Bridgeport, Norristown, Lafayette Hill,
Plymouth Meeting, Erdenheim, Oreland, Flourtown, Ardsley, North Hills,
West Conshohocken, La Mott, Cheltenham, Melrose Park, Elkins Park,
Glenside, Wyncote, Roslyn, Abington, Huntingdon Valley, Rydal,
Meadowbrook, Jenkintown, Hollywood, Rockledge, Somerton,
Bustleton, Torresdale, Holmesburg, Tacony, Kensington, Feltonville,
Frankford, Olney, Andalusia, Cornwells Heights, Bucks County,
Philadelphia County, Delaware County, and Montgomery County, PA.
We can also offer cheaper Pennsylvania workers comp insurance
quotes to your small business located anywhere in the Keystone state,
including in Reading, Lancaster, Allentown, York, and Bethlehem, PA.
Pennsylvania Business Information:
Pennsylvania Business
Insurance Quotes
Workers Comp
Insurance Quote
Your Pennsylvania Workers
Comp Insurance
Quote Source
Lower Bucks
Insurance Associates
1159 Veterans Hwy
Bristol, Pennsylvania 19007
Bucks County PA
(215) 788-3100
Fax: (215) 788-3200
Pennsylvania Workers Compensation Insurance Quote Request
Proudly Serving All
Of Pennsylvania!
Pennsylvania Workers Compensation Insurance Quote
LOWER BUCKS
INSURANCE ASSOCIATES
Lower Bucks Insurance Associates
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