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Select the form that you need from the menu below:

  • Workers' Comp Acord Form (Texas)
  • "NEW" Non-Subscriber/Occupational Accident "WEBQUOTE" Online Form
        (This form designed to be completed online and submitted directly to us via email)
  • Non-Subscriber / Occupational Accident "Fax-A-Quote" Forms
  • Certificate of Insurance Request
  • Non-Subscriber Forms & Notices
        (Division of Workers' Compensation of the Texas Department of Insurance/TDI Required Forms & Notices for Non-Subscribers)

    Need a quote fast?

    We recommend that you print out the appropriate quote form, complete it and fax your submission along with the appropriate loss history to our office.

    Fax: 713-690-8484

    Important: If time is of the essence, please contact our office so we can give your submission special attention. Please refer to our staff page to locate the appropriate person your need to talk to in reference to your particular submission.


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    7826 Hillmont St.
    Houston Tx 77040
    (713)690-8484 fax

    Important Note: This website provides only a simplified description of coverages and is not a statement of contract. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.

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