Workers Compensation Quote — OKC Insurance Brokers

👤 Contact Info

First Name *

Last Name *

Phone *

Email *

Date of Birth (needed to start your quote) *

Business Name (not required)

Additional Owners / Partners

Type of Business *

Limited Liability Company (LLC) Corporation (C Corp or S Corp) Sole Proprietorship Partnership (General or Limited)

EIN (not required)

Is there another owner? (not required)

Yes No

Address *

Owner's Payroll Annually (not required)

Employee's Payroll Annually (not required)

Owner-Only / Ghost Policy? (no employees — a certificate to satisfy contract requirements) *

Yes — owner only, no employees No — I have employees

Do you hire Subcontractors (1099) *

Yes No

Travel Out of State for Work? (not required)

Yes No

Description of Work Performed *

Has your business had work comp coverage? (not required)

Yes No

Years in Business (not required)

Years of experience (not required)

When does your insurance expire? (not required)

Claims in the Last 3 Years? *

Yes No

When do you want your policy to start? *

Do you have anything else you want to let us know? (not required)

How did you hear about us? (not required)

How would you like us to contact you? (not required)

Upload your old policy & 4-5 Year Loss Run Report & Experience Mod Report. (not required)

Up to 5 files total, 10 MB each — PDF, photos, or documents.

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