Form

AmeriProtect Logo-BLUE

Thank you for your interest in our workers' compensation policy! Some of our Workers' Compensation Policies offer the following benefits:

Flexible payment options
EFT Guard
Exclusive discounts
Much more!

We will need the following information in order to obtain a quote for your business.

Questions? Contact Wes Hoffrichter @ 517.367.2225

AmeriProtect is a owned and operated subsidiary of the Michigan Association of Chiropractors.

Company name

First name*

Last name*

Street address*

City*

State/Region*

Postal Code*

Phone number

Email*

Federal ID Number (FEIN)

Years in Business

Total Annual Payroll Amount per Job Classification

For Instance: Clerical, Physician Assistant, Physician

Current Premium Amount

Expiration of Current Policy

Year/Month/Day

Current Policy Carrier

Corporate Officers/Members of an LLC/PC may be excluded from the coverage and also premium. However, a minimum premium of $350 will still apply. If you would like to exclude yourself, please check the box below.

Exclude Myself

How did you hear about us?