Southern Secure.com - Alabama Workers Comp insurance quotes online. Free AL worker's compensation insurance quote - low cost insurance Alabama Workers Comp insurance.

Alabama insurance quotes from Southern Secure Insurance

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Questions to: craig@southernsecure.com

Local Phone: 205-874-6505
Fax: 205-874-6506

Contact Address:
Southern Secure Insurance
2170 Clearbrook Rd., Suite 208
Birmingham, AL 35226

southern secure insurance agency is an independent brokerage

"Remember, All Our Policies Come With an Agent!"
we guarantee your satisfaction!

On-Line Workers Comp Insurance Quote Form One Simple Form - takes only 2-3 Minutes! Your Personal / Company Data:
Your Name:
Your Company's Name:
Street Address:
City:
State: (Must be Alabama)
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again (for accuracy):
Phone:
Fax (optional):


Currently Insured? (If yes, list carrier, and # of years continuous. If none, type NONE)

List Claims & Amounts Paid (If none, type NONE)

Years In Business:

Business type: (proprietorship, corporation, etc.)

FEIN or Social Security #: (now required by all comp carriers to quote)


Underwriting Information:

Describe IN DETAIL, Your Business Operations:

Payroll Class #1:
List Class Code # if you know it, and describe payroll class:	Insert Annual Payroll in dollars for this class here:	$

Payroll Class #2: (if none, leave blank)
List Class Code # if you know it, and describe payroll class:	Insert Annual Payroll in dollars for this class here:	$

Payroll Class #3: (if none, leave blank)
List Class Code # if you know it, and describe payroll class:	Insert Annual Payroll in dollars for this class here:	$


Send my quotation via:	E-Mail Fax Regular Mail

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