Risser & Company | (800) 500-3441 | Workers Compensation Brokerage

You can submit your information for a quote by following steps 1-4 and filling out the form below.

Fill out the Acord 130 and save it to your computer.
You can also use the one from your agency management program.
Scan 4 years of loss runs.
Scan the latest experience mod worksheet.
Upload all these documents in the form below.

*Agency Name:

A value is required.

*First Name:

A value is required.

*Last Name:

A value is required.

*Email:

A value is required.Invalid format.

*Phone Number:

A value is required.Invalid format.

*Upload Acord 130:

A value is required.

*Upload 4 years of Loss Runs:

A value is required.

*Upload Experience Mod Worksheet:

A value is required.

Please enter the text from the image
[ What's This? ] [ Refresh Image ]

*indicates a required field.