Get a Workers Comp Insurance Quote

Sundance Insurance Group

To receive a quote for workers comp insurance, fill out the information below and we'll get back to you right away with a competitive quote.

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Business information

Business name *

Business type

Corporation
LLC
Partnership
Sole proprietorship

Contact information

Contact name *

Address

Phone number *

Email *

Fax number

Website

Additional information

Years in business

Do you have employees or uninsured subcontractors?

Annual payroll for all employees and subcontractors

Effective date of coverage

The date you would like coverage to begin

Description of operations

Experience modification

#of 1099 and W-2 employees

Tax ID #

Current WC carrier

Current WC policy #

Current WC expiration date

Expiring premium (if know)

Payroll class code information

Class code

If known

Class code description

if code is unknown

Est. Payroll for class code

Comments

Binding Agreement

I understand that coverage cannot be bound or altered by this submission request until the information has been specifically confirmed by a Sundance Insurance representative by phone or email.

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702.270.8277
8:00 AM - 5:00 PM, M - F
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If you need help with this form, or if you'd prefer to get a quote by phone or email, please let us know.

Sundance Insurance Group

Our location

9555 Hillwood Dr Ste 140
Las Vegas, Nevada 89134

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702.270.8277

Mon-Fri 8AM-5PM

Get a Workers Comp Insurance Quote

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Sundance Insurance Group

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