← Back Workers Compensation Company Name First Name Last Name Email Address Phone Number Street Address City State —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming New Republic Insurance does not currently offer Workers Comp in the state of NY. Zip Code # of Employees —Please choose an option—No Employees12345678910+ Description Of Business Estimated Annual Payroll Estimated Gross Sales/Revenue Tax ID # Year business began —Please choose an option—Prior to 20002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022 Years of Experience Have you had prior Workers Comp coverage? —Please choose an option—YesNo If you have had previous workers comp coverage, please list the Name of Insurance Company and dates of coverage Desired Limits —Please choose an option—100K/500K/100K500K/500K/500K1M/1M/1M By clicking submit, I agree to receive SMS Text Messages at the above phone number from New Republic Insurance for follow up purposes for insurance products. Message and data rates may apply. Message frequency varies. Text HELP for help. Text STOP to cancel. See Privacy Policy. ← Back