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Request
for Proposal
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Method 1 |
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Complete our online form below and an agent from The Windham
Group, Inc. will contact you! |
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Method 2 |
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You can also print our Request for Proposal form in
Word or PDF
format. Fax: 678-559-0330
Mail:
370 Kendemere Pointe,
Roswell, GA 30075
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In addition we will also need: Current declaration page from
current work comp policy, last three years of work comp "loss runs",
a SUTA report of your annual rate
notices including current rate. |
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Name:
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E-mail Address::
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Phone: |
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Fax: |
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Address: |
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City: |
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State: |
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Zip: |
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Company Name: |
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Business Type: |
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LLC, LLP,
Sole Proprietorship, S-Corp, C-Corp, or Other |
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Tax ID or Social: |
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Website: |
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Business Description: |
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About Your Company |
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Number of Employees: |
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Work Comp Code(s): |
*From your worker's compensation certificate example: 5645 Construction
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Work Comp Modifier (if
known) |
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Current Pay Cycle: |
Weekly,
Monthly. or Semi-Monthly |
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Gross Payroll: |
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Per: |
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week, month, or year |
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Current SUTA Rate: |
*State
Unemployment tax rate |
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Gross Payroll/Work Comp Codes: |
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Payroll/Code |
No. of full-time or
part-time employees |
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Code 1: |
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Payroll/Code
1: |
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Code 2: |
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Payroll/Code
2: |
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Code 3: |
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Payroll/Code
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Code 4: |
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Payroll/Code
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Code 5: |
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Payroll/Code
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Code 6: |
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Payroll/Code
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Contact an agent today! |
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Comments: |
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- Why Wait?
- There is NO COST to you.
- Save time by completing only one RFP!
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The Windham Group, Inc.
370 Kendemere Pointe
Roswell, GA 30075
Phone:
678-576-0101
Fax: 678-559-0330
©
Copyright 2006 *
Disclaimer
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