ABOUT   |   COVERAGES   |   REQUEST A QUOTE   |  SAFETY TIPS   |   FOR PUBLISHERS   |  FOR BROKERS   |  TESTIMONIALS   |  CONTACT

Bookseller Workmens' Compensation Insurance Quote Request

Your name:
Company name:
Mailing address:
Location address:
City:
State:
ZIP:
Phone:
Fax:

E-mail:
Web address (URL):
Description of business:
Federal Employer Identification Number (FEIN):
Unemployment Insurance Account Number (UIAN):
Type of entity: Partnership
Proprietorship
Corporation
Other
Are you a member of Parable? Yes No
Are you a member of Munce? Yes No
Payrolls In Each Class (Please call if you have questions)
Retail Payroll: Total # of employees
Clerical Payroll: Total # of employees
Cafe Payroll: Total # of employees
Owner(s)/
Officer(s) Name(s)
Title
Included/Excluded 
% of ownership
Included
Excluded 		%
Included
Excluded 		%
Workers' Compensation Claims/Loss History
Annual premium
Claims in past 5 years: Yes No
NCCI Experience Modification if known:
How would you like to receive your quote?

E-mail
Fax
Phone
U.S. mail

ABA Member ID Number (if applicable):

 

LIBRIS is owned and operated by the American Booksellers Association. Brokerage firm Beecher Carlson is the program administrator.