Our goal at KaiserInsuranceOnline.com is to secure for our clients the best possible coverage at the lowest possible rates. In order to accomplish this, we need somewhat specific information about your company and its employees. Please take the time to enter and submit the information requested below. We will immediately acknowledge your request and provide your quote to you as soon as possible, typically within three business days.

Please complete the following form. All fields are required.


Employee 1
Employee 2

Requested Effective Date
Your Name
Company Name
Company Address
Industry
Business Type
City
State  
Zip  
Email
Phone



Proof of Business: Proof of business documentation must be for the company applying for coverage. ONE of the following are acceptable proofs of business.

Proof of Employment: ONE of the following are acceptable proofs of Employment