Howard Leasing - Professional Employee Services

6302 Manatee Av. West, Suite K Bradenton, Florida 34209
Phone: (941) 761-7704
Toll Free: 866-761-2884
Fax: (941) 761-7706
Email us

Quick Quote

Howard Leasing Professional Employee Services is pleased
to offer you a detailed proposal.

Please fill in all the information below.

Company Name:
Address:
City:	State: Zip Code:
Phone:
Fax:
E-mail:
Contact person(s):
Description of business:
Your pay cycle:	weekly bi-weekly semi-monthly monthly
# of locations:

Workers Comp Classification Code*		State	# of Employees	Annual Payroll











1.) Current Experience Modification?

2.) Do you have a workers compensation claim/loss problem?				Yes No Maybe

3.) Do you have copies, or can you get copies, of your most recently evaluated workers compensation loss runs?				Yes No Maybe

(Workers compensation class codes can be found on the declaration page of your workers compensation policy...if a new business, describe the duties of your employees) *The quote you receive will be contingent on satisfactory workers compensation information/loss runs and/or satisfactory loss control visit.
By choosing yes here and CLICKING the SUBMIT BUTTON BELOW YOU AGREE TO THE FOLLOWING STATEMENT. To the best of my knowledge, I represent that all answers and statements of this form are complete and true. Misrepresentations or misstatements may result in termination of contract.

Regional offices in Satellite Beach, Stuart, and Pensacola.