Request a Quote for Workers' Compensation Insurance

Request a workers' compensation insurance quote for group or individual self-insurance programs administered by NCAComp, headquartered in Buffalo, New York.

Company name:

Business Description:

Legal Structure:

Sole Proprietorship Partnership Corporation Other

# of years in business:

Experience modifier:

Current carrier:

Anniversary Date:

Contact Name:

Phone #:	Fax #:

Email:

Provide me a quote using the following payrolls and classifications:

Code #	Code Description	Annual Payroll
8809	Executive Officers
8810	Clerical office workers
8742	Outside salespeople

Click the above "Submit" button, or else print out this form and fax it to NCAComp at (716) 842-0018.