workers' comp quote request.

complete the questionnaire below to receive a workers' compensation insurance quote. cimplx does not mark up quotes — E-COMP provides quotes directly to you.

your contact information.

Your Name *

Your Email *

Phone Number *

business information.

Desired Effective Date *

Legal Business Name *

DBA(s)

Entity Type *

FEIN # (Tax ID) *

All Physical Addresses *

Mailing Address *

operations & payroll.

Detailed Business Description of Operations *

Estimated Annual Payroll (for employees) *

Owner Names, Titles, and % of Ownership *

current coverage & claims.

Current Policy Carrier & Expiration Date

Workers' Compensation Claims Within the Last 3 Years

If losses are present, a Loss Run Report is required. Our team will follow up with you.

Do You Use 1099s or Subcontractors?

Your information will be sent to E-COMP for a direct quote. A copy will also be sent to your email.

why choose E-COMP through cimplx?

No Upfront Deposits

Start coverage without large upfront premium payments

Pay Based on Actual Payroll

Premiums calculated from real payroll data, not estimates

50+ A-Rated Carriers

Access to top-rated insurance carriers nationwide