Littman Insurance, Serving the Insurance Needs of Michigan, Illinois, and Indiana Residents and Businesses
Meeting the Insurance Needs of Michigan, Illinois and Indiana Residents & Businesses for over 20 Years!
 
Our Personal Lines Markets
Personal Auto Insurance

Motorcycle Insurance

Homeowners Insurance

Renter's Insurance

Boat Insurance

Life Insurance

Health Insurance


Our Commercial Lines Markets
Business Owners Insurance

General Liability

Commercial Property

Franchise Motel Program

Commercial Automobile

Workers Compensation

Surety & Fidelity Bonds

Builder's Risk Insurance


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Service My Account

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The Littman Agency Offers You a Satisfaction Guarantee!

   
On-Line Workers
Compensation Quote Form
One Simple Form - takes only 2-3 Minutes!
Your Personal / Company Data:

Your Name:
Your Company's Name:
Street Address:
City:
State:
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again (for accuracy):
Phone:
Fax (optional):
 

Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type NONE)
 
List Claims & Amounts Paid
(If none, type NONE)
 
Years In Business:
 
Business type:
(proprietorship, corporation, etc.)
 

 
Underwriting Information:
 
Describe IN DETAIL,
Your Business Operations:
 
Payroll Class #1:
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here: 		$
 
Payroll Class #2: (if none, leave blank)
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here: 		$
 
Payroll Class #3: (if none, leave blank)
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here: 		$
 
 
Send my quotation via: E-Mail Fax
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The Littman Insurance Agency | 1200 E. Chicago | Sturgis, MI 49091
Toll Free Phone: 1-800-431-8873 | Phone: 1-269-651-6311 | Fax: 1-269-651-2925
Our Normal Office Hours are: 9:00 to 5:00, Weekdays. | View Our Privacy Notice
Email Us: tim@littmaninsurance.com | Website Design © 2006, Insurance Web Sales