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Karn Sitkins Payette Insurance Agency, Inc.
On-Line Customer Service
Workers Comp Quote Request
Please note: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member.
Your name:
Email:
Phone:
Name of business:
Business address: Street

City, State, Zip
  
Type of business:
Current Carrier:
Current Effective date:
Number of employees:
Total Payroll (Excluding owners/officers):
Are owners/officers to be covered?     Yes     No

Experience Mod (If known):
Please include any additional information/instructions here:
If you have not received a response from us within one business day, please contact us again.
 
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1420 Ford Avenue   Wyandotte, MI 48192
734-285-5600 • 734-285-6416 Fax		   22976 West Outer Drive   Dearborn, MI 48124
313-563-7040 • 313-274-4949 Fax
Copyright © 2009 • Karn Sitkins Payette Insurance Agency, Inc.
Thursday, September 09, 2010