Price Indicator

Please correct the following.

*Business Type:

Zip Code	Work Classification	# of Full-time Employees	# of Part-time Employees	Payroll Amount	Delete

No Records

Have you been in business (with employees) and had workers’ compensation insurance for the last 36 months?	Yes	No
Have you had any workers’ compensation claims in the last 36 months?	Yes	No

*Disclosure:

The premium provided is subject to verification of the information you have provided. If you would like to obtain a quote from State Fund, please save your submission, then continue to enter additional applicant information to complete your New Quote Request. If you prefer, you may save your submission as a draft and return later to complete your submission.