New Jersey Workers
Compensation Insurance Quote
We provide comprehensive Workers Comp
Insurance services throughout New Jersey!
Your Life Solutions of Long
Valley, NJ offers
comprehensive Commercial
Insurance coverage options
and experienced business
insurance services throughout
New Jersey.
Contact us about Property,
Group Health, Auto, and
Liability Insurance for your
New Jersey business.

In addition toWorkers Comp
Insurance, we also offer
affordable Business Liability
Insurance plan services.
We are your local northern New Jersey insurance agency, offering comprehensive
workers compensation insurance services to businessess in the following cities
and counties: Succasunna, Boonton, Boonton Township, Brookside, Budd Lake,
Butler, Cedar Knolls, Chatham, Chester, Convent Station, Denville, Dover, Dover
Annex, East Hanover, Fayson Lakes, Flanders, Florham Park, Gillette, Green Village,
Greystone Park, Hibernia, High Crest, Ironia, Kenvil, Kinnelon, Lake Hiawatha, Lake
Hopatcong, Lake Intervale, Landing, Ledgewood, Lincoln Park, Lindy Lake, Long
Valley, Lower Montville, Lyonsville, Madison, Mendham, Meriden, Millington, Mine
Hill, Montville, Montville Township, Morris Plains, Morristown, Mount Arlington, Mount
Freedom, Mount Olive, Mount Tabor, Mountain Lakes, Netcong, New Vernon,
Parsippany, Pequannock, Pequannock Township, Picatinny Arsenal, Pine Brook,
Pinebrook, Pompton Junction, Pompton Plains, Powerville, Ralston, Randolph,
Riverdale, Rockaway, Rockaway Valley, Schooleys Mountain, Stirling, Tabor,
Taylortown, Towaco, Troy Hills, Wharton, Whippany, Stanhope, Hopatcong,
Espanong, Hurdtown, Cranberry Lake, Andover, Greendell, Woodport, Springdale,
Oak Ridge, Milton, Sparta, Lake Lenape, Newton, Ogdensburg, Saxton Falls,
Johnsonburg, Allamuchy, Vienna, Hackettstown, Beattystown, Marksboro, Hope,
Townsbury, Washington, Newark, Elizabeth, Rahway, Colonia, Iselin, Avenel,
Woodbridge, Port Reading, Carteret, Perth Amboy, Fords, South Amboy, Metuchen,
Plainfield, Dunellen, South Plainfield, Green Brook, Fanwood, North Plainfield,
Cranford, Scotch Plains, Westfield, Union, Millburn, Springfield, Mountainside,
Gillette, Warren, Watchung, Stirling, Millington, Middlesex, Martinsville, Piscataway,
Edison, New Brunswick, Highland Park, Somerset, Milltown, South River, Bound
Brook, Somerville, Bridgewater, Fairview, Ridgefield, Fort Lee, Leonia, Palisades
Park, Englewood Cliffs, Englewood, Bergenfield, Teaneck, Paramus, Bogota,
Ridgefield Park, Little Ferry, Hackensack, Maywood, Teterboro, South Hackensack,
Rochelle Park, Moonache, Lodi, Hasbrouck Heights, Saddle Brook, Garfield,
Elmwood Park, Woodridge, Carlstadt, East Rutherford, Lyndhurst, Rutherford,
Wallington, Passaic, Clifton, Paterson, Totowa, West Paterson, Little Falls, Great
Notch, North Caldwell, Cedar Grove, Verona, Montclair, Bloomfield, West Orange,
Glen Ridge, Belleville, Nutley, Kingsland, North Arlington, Kearney, Harrison, East
Orange, East Newark, Orange, Irvington, South Orange, Hillside, Townley,
Livingston, Wayne, Morris County, Sussex County, Somerset County, Pasaic County,
Bergen County, Hunterdon County, Union County, and Warren County, NJ. We also
offer workers compensation insurance services throughout the state of New Jersey,
including the greater New York City area.
Business Name:    
Premises Address:
City:
State:  (New Jersey or New York)
Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required) 

About Your New Jersey 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 New Jersey 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

New Jersey 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
New Jersey Workers Compensation Insurance quote request.**


**Information received from this New Jersey Workers Compensation Insurance
quote request form sent to Your Life Solutions, 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 workers compensation insurance policy 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 New Jersey Workers Compensation Insurance Policy. We are
licensed in New Jersey, New York, and will not provide quotes for other
states.


New Jersey Business Information:
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