Restaurant Work Comp

Restaurant Work Compbdirectadmin2020-02-08T00:36:39+00:00

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Contact Information
Name*
First Last
Email*
Enter Email Confirm Email
Phone*
Where should we send your official documents?*
Street Address Address Line 2 City State ZIP Code

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Business Information
What is your effective date of coverage?*
Date Format: MM slash DD slash YYYY
What is your legal business name?*
If you are a Franchisee, what brand or DBA?
What type of legal entity is your business?*
What is your Tax ID (Employer Tax ID/FEIN)?

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Payroll and Exp. Mod Information
What is your Experience Mod. (If unknown, enter 1.0)?*
Please enter a number from .25 to 3.00.
What is your Estimated Annual Restaurant Payroll?*
What is your Estimated Annual Office/Clerical Payroll?
Do you have employees working in multiple states?*
- No
- Yes
Number of locations?*

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Submission
Don't worry. You will be able to make changes to any of the information you provided online when you review with a representative over the phone.

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