Business Name:    
Premises Address:
Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required) 

About Your Texas 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 Texas 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

Recent Insurance Information:

Current Insurance Company: 
Policy #: Expiration Date: (mm/dd/yyyy)
Losses past 3 years:
Description of losses or loss runs:

Which insurance coverages do you currently have:
Texas Commercial Auto
Texas Commercial Liability
Texas Commercial Property
Texas Workers Comp
Texas Group Health
Texas Group Life
Texas Group Disability
Texas Group Long Term Care

Texas Employee Information:

Employee       Classification Code       Yearly Payroll Estimate
      1                                         $
      2                                         $
      3                                         $
      4                                         $
      5                                         $

Officers / Partners / Owners Information:

Principal             Name                                           Title                        Include

Additional Information or Comments

Click on the "Submit Quote Request" button below to send your
Texas Workers Compensation Insurance quote request.**

**Information received from this Texas Workers Compensation Insurance
quote request form sent to Texans Insurance & Financial Group 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 Texas workers compensation insurance 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 Texas Workers Compensation Insurance policy. We are
licensed in Texas and will not provide workers comp insurance quotes
in other states.

Texas Workers Comp
Insurance Quote
We can provide comprehensive Texas
Workers Comp Insurance coverage services
in the Fort Bend County area and throughout Texas!
Texans Insurance &
Financial Group of Sugar
Land, TX offers
comprehensive commercial
insurance coverage options
and affordable business
insurance services
throughout Texas.
Contact us about Texas
Commercial Auto,
Commercial Property, Group
Health, Workers Comp, and
General Liability Insurance
toll free at 800-747-6140.
In addition to Texas Workers
Comp Insurance, we also
offer low cost Commercial
Auto Insurance plan services.
We are a Sugar Land, TX insurance agency offering affordable Texas
workers comp insurance quotes to mid-sized, large and small businesses
in the following towns, cities and counties in southeast Texas: Meadows,
Town West, Four Corners, Crabb, Booth, Thompsons, Fresno, Manvel,
Pleak, Kendleton, Eagle Lake, Sandy Point, Beasley, Rosenberg,
Richmond, Orchard, Fulshear, Juliff, Arcola, Needville, Frydek, Rosharon,
Bonney, East Bernard, Lissie, Elm Grove, Spanish Camp, Wharton, Guy,
Bellville, Wallis, Pasadena, Deer Park, Houston, Pearland, Galena Park,
Jacinto City, La Porte, Bellaire, West University Place, Cloverleaf,
Beaumont Place, Spring Valley, South Houston, Iowa Colony, Hilshire
Village, Humble, Houmont Park, Friendswood, League City, Alvin,
Mission Bend, Stafford, Missouri City, Texas City, Webster, Dickinson,
Baytown, Channelview, Highlands, Seabrook, Bacliff, La Marque, Jersey
Village, Lake Jackson, Surfside Beach, Algoa, Santa Fe, Barker, Katy,
Sealy, Dayton, Angleton, Freeport, Bammel, Kohrville, Bay City,
Brenham, Addicks, Brookshire, San Felipe, Hockley, Waller, Prairie
View, New Caney, Beach City, Nassau Bay, North Houston, Hempstead,
Tomball, The Woodlands, Burr, Iago, Boling, Peters, Cat Spring, Burleigh,
Waller County, Wharton County, Brazoria County, Harris County, and
Fort Bend County, TX. We can also offer affordable Texas workers comp
insurance policy quotes to businesses throughout the Lone Star state,
including in Beaumont, Austin, Waco, Fort Worth, Dallas, and San
Antonio, TX.

Texas Business Information:
Texans Insurance
& Financial Group
101 Southwestern Blvd.
Suite 230
Sugar Land, Texas 77478
Fort Bend County, TX
Office: (281) 277-7800
Toll Free: (800) 747-6140
Fax: (281) 277-7801

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