TechRUG logo

Workers Compensation (WC) Application

Company Name
Street Address, Include Floor #
City
State
Zip
Tel #
Contact Name
Contact Title
Contact Tel#
Contact e-mail
Website (if any)
FEIN
# of Employees (not partners/owners)
Estimated Annual Payroll, excluding Partners/Owners
Description of duties for these employees
# of Partners/Owners
Estimated Annual Payroll for Partners/Owners
Description of duties for these owners/partners

TechRUG - We've got IT covered!