Online Quote - Emplicity PEO & HR Outsourcing

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Step 1 of 4 - Company

Company Information
Business Name*
Contact*
Title*
Phone*
Email*

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Details
Primary Address*
Zip*
# Full-time Employees*
# Part-time Employees*
Federal ID # (If Known)
Business Description
Tell us about your company's products, services and employees' job functions.

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Workers' Compensation
Are you interested in Workers' Comp?
- Yes
- No
Do you have more than 5 Workers' Comp Classifications?
- Yes
- No
Click 'Next' to continue.
Please upload a file with each workers' compensation class code listed individually -- if you do not currently have workers' compensation insurance, please complete the number of employees under each job description as well as their combined yearly remuneration. If you currently have a workers' compensation policy, please also list your current rates for each class code.

Please include:
State
Code (If known)
Class Code Description
Effective Rate Per $100 of Payroll (If known)
# Full-time Employees (Over 30 hrs/week)
# Part-time (Under 30 hrs/week)
Estimated Annual Payroll
File
Drop files here or

Max. file size: 200 MB.
Please list each workers' compensation class code individually below--if you do not currently have workers' compensation insurance, please complete the number of employees under each job description as well as their combined yearly remuneration. If you currently have a workers' compensation policy, please also list your current rates for each class code.
Workers' Comp Classification #1
State
CODE (If Known)
Effective Rate
Workers' Comp Class Code Description (If Known)
#Full-time
Over 30 hrs/week
#Part-time
Under 30 hrs/week
Estimated Annual Payroll
Workers' Comp Classification #2
State
CODE (If Known)
Effective Rate
Workers' Comp Class Code Description (If Known)
#Full-time
Over 30 hrs/week
#Part-time
Under 30 hrs/week
Estimated Annual Payroll
Workers' Comp Classification #3
State
CODE (If Known)
Effective Rate
Workers' Comp Class Code Description (If Known)
#Full-time
Over 30 hrs/week
#Part-time
Under 30 hrs/week
Estimated Annual Payroll
Workers' Comp Classification #4
State
CODE (If Known)
Effective Rate
Workers' Comp Class Code Description (If Known)
#Full-time
Over 30 hrs/week
#Part-time
Under 30 hrs/week
Estimated Annual Payroll
Workers' Comp Classification #5
State
CODE (If Known)
Effective Rate
Workers' Comp Class Code Description (If Known)
#Full-time
Over 30 hrs/week
#Part-time
Under 30 hrs/week
Estimated Annual Payroll
Phone
This field is for validation purposes and should be left unchanged.

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Cookie	Duration	Description
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Cookie	Duration	Description
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Cookie	Duration	Description
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We’ve made getting a quote, simple.

Step 1 of 4 - Company

Company Information

Details

Benefits

Benefit Type

Medical

Dental

Vision

Life

Long-Term Disability

Short-Term Disability

401k

Supplemental

Workers' Compensation

Workers' Comp Classification #1

Workers' Comp Classification #2

Workers' Comp Classification #3

Workers' Comp Classification #4

Workers' Comp Classification #5

Cookie	Duration	Description
_clck	1 year	No description
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handl_landing_page	1 month	No description available.
handl_original_ref	past	No description available.
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handl_url	1 month	No description available.
li_gc	2 years	No description
referrer_user_id	14 days	No description available.
SM	session	No description available.
username	past	No description available.
wmc	10 years	No description available.