Our goal at KaiserInsuranceOnline.com is to secure for our clients the best possible coverage at the lowest possible rates. In order to accomplish this, we need somewhat specific information about your company and its employees. Please take the time to enter and submit the information requested below. We will immediately acknowledge your request and provide your quote to you as soon as possible, typically within three business days.

Please complete the following form. All fields are required.

Proof of Business: Proof of business documentation must be for the company applying for coverage. ONE of the following are acceptable proofs of business.

• 1065 Annual Income Tax Return
• 1120 Annual Income Tax Return
• 990 or 990 EZ Annual Income Tax Return
• 941 Quarterly Wage and Tax
• 940 Annual Wage and TAx
• Tax Exempt Form
• 1040 Individual Income Tax Return

Proof of Employment: ONE of the following are acceptable proofs of Employment

• UITR Unemployment Insurance Tax Report
• Payroll Records
• Schedule K-1 (for each share holder)