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The Host Insurance group guarantees 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 Texas)
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)
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class here:
$
 
 
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Texas insurance quotes
The Host Insurance Group | Email: insservice@pdq.net
Toll Free Phone: 866-683-3535 | Local Phone: 281-342-3276 | FAx: 281-342-3513
201 Jackson Street | Richmond, TX 77469 |Terms of Use/Privacy Notice | (This page last updated June 2011)
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Texas insurance quotes

The Host Insurance Agency offers A rated insurance from a variety of providers to ensure the best rates with
the best coverages. We offer fast, friendly and hassle-free service. Call us today for your quote on renters,
flood, condo, homeowners, auto, commercial, workers compensation, medical and life insurance needs.

Areas we service include these Texas cities: Abilene, Alvin, Amarillo, Angleton, Arlington, Atascocita, Austin, Bay City,
Baytown, Beaumont, Brenham, Bryan, Channelview, College Station, Conroe, Corpus Christi, Dallas, Denton, El Paso, Fort Worth,
Friendswood, Galveston, Houston, Humble, Huntsville, Katy, Kerrville, Lake Jackson, Longview, Lubbock, Missouri City, New Braunfels,
Pasadena, Pearland, Richmond, Rosenberg, San Antonio, Seguin, Spring, Sugar Land, Temple, The Woodlands, Tyler, Uvalde, Victoria, Waco.