916-749-4078 info@vl-insurance.com

Please complete the form below to submit a quote request for workers’ compensation. If you have trouble with the form or would prefer to send a PDF version, download our Request a Quote form here, and email your completed form to info@vl-insurance.com.

Request a Quote

Payroll Information

Business 1

Business 2 (If applicable)

Business 3 (If applicable)

List each owner/officer to be excluded from the policy. Please include ownership percentage (100% of stock accounted for) and Title (i.e. Pres, VP, Secretary, etc.)

¬†Questions about this form or our Business Insurance options? Contact us at info@vl-insurance.com¬†and we’ll contact you as soon as possible.