Workers Comp Form

Let USA save you up to 17% on your payroll, Health and Worker’s Comp. Fill out this form and find out what your savings will be!

Name*
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Phone*
Email*
Company Name
Years in Business
Address
Street Address City State ZIP Code
Existing Carrier Information
Workers Comp Policy
Provide your workers compensation policy (esp first two pages, information pages) or fax it to 888-884-2193.
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