Group Rating

Fill out the following information. All information is kept strictly confidential. It will be emailed to one of our representatives where it can provide basic information about your policy and claims history necessary to make an analysis. We should get back to you within one week with a quote as it takes time to retrieve information from the Ohio Bureau of Workers’ Compensation

Fields marked with * are required

Company Name *
City *
State *
How did you hear about us? *
I agree to the terms and services *

If you would rather Download the Official BWC AC-3 please click here.

Once the form is filled out and signed, please e-mail, fax or mail it to us.




FAX - 614-219-1292


PO Box 880

Hilliard, OH 43026