Is pleased to offer E-COMP – payroll and workers’ compensation
in one integrated, pay-as-you-go program
How is E-COMP different from a traditional policy?
Traditional Workers’ Comp.
Deposit/
Down Payment
Premium
Reports
Audit
No Deposit/No Down Payment
Actual payroll at each pay period
No reports to complete
Handled internally, minimal adjustments,
no additional paperwork
25% Minimum
Estimated, based on projected
Monthly/Quarterly audit reports
On site audit, documentation,
additional premium due or refund
Get a Quote… See the Difference!
Company Name
Address
City State Zip
Phone Cell
Contact Name Email
Years in Business FEIN
Entity Type (Corp/Partnership/Individual)
Type of Business/Description of Operations
Current Workers Comp Insurance Carrier/Policy Number
Renewal Date Payroll Client #
Payroll Rep Phone Number/Email
Number of Employees (Full Time/Part Time)
Any losses during the last 5 years?
Class Code Estimated Annual Payroll
Class Code Estimated Annual Payroll
Payroll Frequency 1st Check Date
Let E-COMP do the Shopping for You
Multiple Carriers, Expertise and Exceptional Service All in One Place
Phone: 888-493-2667 | Fax: 888-738-9097 | Online: goecomp.com
Lic. #0C41366
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