Have you compared Workers' Comp rates in the past year?
Yes No
Are you satisfied with your current coverage?
Yes No
Have you filed any Workers' Comp claims recently?
Yes No
Do you feel you are getting personalized service from your current provider?
Yes No
Would you consider switching your Workers' Comp insurance provider?
Yes No
What is your biggest concern regarding your current Workers' Comp insurance?
All set, how can we reach you?
Name
Email
Phone
(Details here)
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