Business Name:    
Premises Address:
City:  
GEORGIA
Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required) 

About Your Georgia Business:

Federal Employer's ID #:
Description of Operations or SIC code:


# of full-time employees:     # of part-time employees:
# of locations:     Estimated Annual Payroll: $
Experience Mod (if any, per policy)

Select all that apply to your Georgia business:
Operate or lease aircraft/watercraft     Work Underground
Work above 15 feet                           Require out of state travel
Use Subcontractors                            Delivery Service
Pre-employment physicals                   Offer safety incentive programs
Store, treat, dispose, or transport hazardour waste
Work on vessels, docks, or bridges over water
Other

Recent Insurance Information:

Current Insurance Company: 
Policy #: Expiration Date: (mm/dd/yyyy)
Losses past 3 years:
Description of losses or loss runs:


What types of coverages do you currently have:
Commercial Auto
Commercial Liability
Commercial Property
Workers Comp
Group Health
Group Life
Group Disability
Group Long Term Care
Other

Georgia Employee Information:

Employee       Classification Code       Yearly Payroll Estimate
      1                                         $
      2                                         $
      3                                         $
      4                                         $
      5                                         $

Officers / Partners / Owners Information:

Principal             Name                                          Title                    Include
      1             
      2             
      3             

Additional Information or Comments



Click on the "Submit Quote Information" button below to send your
Georgia Workers Compensation Insurance quote request.**

**Information received from this Georgia Workers Compensation Insurance
quote request form sent to JRS Risk Services will be for our use only
and will not be sold, given to or distributed to any other parties. A quote will be
based on the Georgia workers compensation insurance information provided
and does not guarantee acceptance of the risk by us. The precise
coverage afforded is subject to meeting underwriting guidelines, and the
terms, conditions and exclusions of the policy as issued. By submitting this
request you acknowledge that this is neither an offer to insure nor a
guarantee of insurance. Completion of this form does not entitle your
business to a Georgia Workers Compensation Insurance policy. We are
licensed in Georgia and will not provide workers comp insurance quotes
for other states.


Georgia Workers Comp
Insurance Quote
We can provide comprehensive Georgia
Workers Comp Insurance coverage services
in the Atlanta, GA area and throughout Georgia!
JRS Risk Services of Atlanta,
GA offers comprehensive
commercial insurance coverage
options and experienced
business insurance services
throughout Georgia.
Contact us about Georgia
Business Liability, Commercial
Auto, Business Owners,
Professional Liability, and
Business Property Insurance at
(678) 921-4650.
In addition to a Georgia
Workers Comp Insurance
quote, we also offer affordable
Business Liability Insurance
plan quotes.
We are an Atlanta, GA insurance agency offering affordable Georgia workers
comp insurance quotes to businesses in the following cities and counties in
Georgia: Smyrna, Douglasville, Vinings, Oakdale, Sandy Springs, Marietta,
Riverside, Carey Park, Adamsville, Bolton, Center Hill, Grove Park, Buckhead,
Morningside, Fair Oaks, Privette Heights, Dunwoody, Chamblee, Doraville,
Skyland, Brookhaven, Embry Hills, Oak Grove, Rehoboth, Vista Grove, East
Marietta, Toco Hills, North Druid Hills, Decatur, Scottdale, Clarkston,
Belvedere, Pendley Hills, South Decatur, Druid Hills, Gresham Park, Avondale
Estates, Panthersville, North Decatur, Cedar Grove, Conley, Forest Park,
College Park, East Point, Stockbridge, Morrow, Riverdale, Stone Mountain,
Union City, Mableton, Lithia Springs, Winston, Douglasville, Austell, Powder
Springs, Hiram, Dallas, Kennesaw, New Hope, Kennesaw, Acworth,
Woodstock, Roswell, Alpharetta, Norcross, Duluth, Gainesville, Buford,
Auburn, Winder, Cartersville, Rome, Cedartown, Peachtree City, Buckhead,
Canton, Cumming, Braselton, Sugar Hill, Hoschton, North Atlanta, Tucker,
Pine Lake, Mountain Park, Glen Haven, Belmont, Redan, Pittsburg, Lilburn,
Luxomni, Snellville, Five Forks, Centerville, Whitney, Pannell, Lithonia,
Dialtown, Flint Hill, Conyers, Milstead, Klondike, Panola, Snapfinger, Magnet,
Gloster, Bethesda, Pleasant Hill, Pittman, Mechanicsville, Meadow, Berkeley
Lake, Lawrenceville, Forest Hills, Suwanee, Northwoods, East Lake, East
Atlanta, Oakhurst, La Vista, Brookhaven, Doraville, Fulton County, Dekalb
County, Forsyth County, Gwinnett County, Walton County, Newton County,
Paulding County, Douglas County, Cherokee County, and Cobb County, GA.
We also offer experienced Georgia workers compensation insurance quotes
throughout the Peach state, including in Macon, Columbus, Augusta, Athens,
and Savannah, GA.
Georgia Business
Insurance Quotes
Georgia Business Information:
JRS Risk Services
2727 Paces Ferry Rd. SE
Building 1, Suite 260
Atlanta, Georgia 30339
Cobb County, GA
Office: (678) 921-4650
Fax: (678) 921-4651
Your Georgia Workers Comp
Insurance Quote Connection
JRS Risk Services
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