Workers Compensation
Insurance Quote
We provide comprehensive Workers Comp
Insurance services throughout New Jersey!
In addition toWorkers Comp
Insurance, we also offer
affordable Business Liability
Insurance plan services.
Business Name:    
Premises Address:
City:
State:  (New Jersey, Pennsylvania or New York)
Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required) 

About Your New Jersey Business:

Federal Employer's ID #:
Description of Operations or SIC code:


# of full-time employees:     # of part-time employees:
# of locations:     Estimated Annual Payroll: $
Experience Mod (if any, per policy)

Select all that apply to your New Jersey business:
Operate or lease aircraft/watercraft     Work Underground
Work above 15 feet                           Require out of state travel
Use Subcontractors                            Delivery Service
Pre-employment physicals                   Offer safety incentive programs
Store, treat, dispose, or transport hazardour waste
Work on vessels, docks, or bridges over water
Other

Recent Insurance Information:

Current Insurance Company: 
Policy #: Expiration Date: (mm/dd/yyyy)
Losses past 3 years:
Description of losses or loss runs:


What types of coverages do you currently have:
Commercial Auto
Commercial Liability
Commercial Property
Workers Comp
Group Health
Group Life
Group Disability
Group Long Term Care
Other

New Jersey Employee Information:

Employee       Classification Code       Yearly Payroll Estimate
      1                                         $
      2                                         $
      3                                         $
      4                                         $
      5                                         $

Officers / Partners / Owners Information:

Principal             Name                                          Title                    Include
      1             
      2             
      3             

Additional Information or Comments



Click on the "Submit Quote Information" button below to send your
New Jersey Workers Compensation Insurance quote request.**

**Information received from this New Jersey Workers Compensation Insurance
quote request form sent to New Penn Insurance Associates, will be for our use only
and will not be sold, given to or distributed to any other parties. A quote will be
based on the workers compensation insurance policy information provided
and does not guarantee acceptance of the risk by us. The precise
coverage afforded is subject to meeting underwriting guidelines, and the
terms, conditions and exclusions of the policy as issued. By submitting this
request you acknowledge that this is neither an offer to insure nor a
guarantee of insurance. Completion of this form does not entitle your
business to a New Jersey Workers Compensation Insurance Policy. We are
licensed in New Jersey, New York, Pennsylvania and will not provide quotes
for other states.


NJ or PA Business Information:
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NEW PENN
INSURANCE ASSOCIATES
New Penn Insurance Associates
83 Princeton Avenue
Suite 3D
Hopewell, New Jersey 08525
Mercer County, NJ
(609) 466-5300
Toll Free: (800) 927-7475
Fax: (609) 466-7289
New Penn Insurance Associates
538 Street Road, Suite 200
PO Box 578
Southampton, PA 18966
New Penn Insurance Associates
of Hopewell, NJ offers
comprehensive Commercial
Insurance coverage options and
experienced business insurance
services throughout New Jersey
and Pennsylvania.
Contact us about Property,
Group Health, Auto, and
Liability Insurance for your New
Jersey or Pennsylvania business
at 609-466-5300.
New Jersey Workers
Comp Insurance Quote
New Jersey Business
Insurance Quotes
(New Jersey & Pennsylvania)