Workers'CompensationBrokers
we shop work comp for insurance agents
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Workers Compensation Brokers: Forms Library
We want to be your work comp solution
General Forms
Insurance Shop
Acord 130 (pdf form fillable)
Work Comp Loss Affidavit (fillable)
Request Loss Runs: Example Letter- Word Doc
Cert Request Form (pdf form fillable)
NCCI Mod Release Authorization
ERM-14 Form- Ownership Information
ALPHABETICAL
Click Here for State Specific Insurance Forms
Broker Agreement
Federal W-9 Form
ACH Authorization Form- Insurance Shop
ACH Authorization Form- PaySmart Payroll
ACH Authorization Form- PaySmart (no fee)
WORKERS' COMPENSATION BROKERS- HOME
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All rights reserved. Columbia, Missouri- MO
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We want to be your work comp solution
