Workers Compensation Quick Cost Estimator 1. Company (required) Contact (required) Phone (required) Email (required) 2. Estimated Payroll/Commissions paid to your agents/employees for the following services: 8741 – Real Estate Sales (including clerical): 8740 – Property Management (not on site): 9015 – Property Management (maintenance): 8743 – Mortgage Brokering (including clerical): 3. Number of full time employees/agents: Number of part time employees/agents: 4. Any claims within the past 3 years? YesNo 5. Current Workers Comp Provider: Renewal Date:
