Business Name:    
Premises Address:
South Carolina
Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required) 

About Your South Carolina Business:

Federal Employer's ID #:
Description of Operations or SIC code:

# of full-time employees:     # of part-time employees:
# of locations:     Estimated Annual Payroll: $
Experience Mod (if any, per policy)

Select all that apply to your South Carolina business:
Operate or lease aircraft/watercraft     Work Underground
Work above 15 feet                           Require out of state travel
Use Subcontractors                            Delivery Service
Pre-employment physicals                   Offer safety incentive programs
Store, treat, dispose, or transport hazardour waste
Work on vessels, docks, or bridges over water

Recent Insurance Information:

Current Insurance Company: 
Policy #: Expiration Date: (mm/dd/yyyy)
Losses past 3 years:
Description of losses or loss runs:

Which insurance coverages do you currently have:
South Carolina Commercial Auto
South Carolina Commercial Liability
South Carolina Commercial Property
South Carolina Workers Comp
South Carolina Group Health
South Carolina Group Life
South Carolina Group Disability
South Carolina Group Long Term Care

South Carolina Employee Information:

Employee       Classification Code       Yearly Payroll Estimate
      1                                         $
      2                                         $
      3                                         $
      4                                         $
      5                                         $

Officers / Partners / Owners Information:

Principal             Name                                           Title                        Include

Additional Information or Comments

Click on the "Submit Quote Request" button below to send your
South Carolina Workers Compensation Insurance quote request.**

**Information received from this South Carolina Workers Compensation Insurance
quote request form sent to Russell-Massey & Company will be for our use
only and will not be sold, given to or distributed to any other parties. A quote
will be based on the South Carolina workers compensation insurance
information provided and does not guarantee acceptance of the risk by us. The
precise coverage afforded is subject to meeting underwriting guidelines, and the
terms, conditions and exclusions of the policy as issued. By submitting this
request you acknowledge that this is neither an offer to insure nor a
guarantee of insurance. Completion of this form does not entitle your business
to a South Carolina Workers Compensation Insurance policy. We are licensed
in South Carolina and will not provide workers comp insurance quotes in other

South Carolina Worker Comp
Insurance Quote
We can provide less expensive South Carolina
Worker Comp Insurance coverage quotes for your
mid-sized, large, or small South Carolina business!
Russell-Massey & Co. of
Columbia, SC offers
comprehensive commercial
insurance coverage options
and affordable business
insurance services throughout
South Carolina.
Contact us about South
Carolina Group Health,
Commercial Auto, Commercial
Property, General Liability,
Worker Comp, Contractor, and
Business Owners Insurance
toll free at (800) 849-7475.
In addition to South Carolina
Worker Comp Insurance
quotes, we also offer
affordable Commercial
Property Insurance quotes.
We are a Columbia, SC insurance agency offering affordable South
Carolina worker comp insurance quotes to mid-sized, large, and
small businesses in the following towns, cities and counties in South
Carolina: Chapin, Arthurtown, Saluda Terrace, Sandwood, Arcadia
Lakes, Cayce, Olympia, Forest Acres, Dentsville, Eau Claire, West
Columbia, Springdale, Denny Terrace, Belmont, St. Andrews, Irmo,
Oak Grove, Lexington, Galaxy, Bluff Estates, Hazelwood Acres,
State Park, Haskell Heights, Lincolnshire, Ballentine, Killian, Red
Bank, South Congaree, Edmund, Gilbert, Summit, Gaston, Hopkins,
Capitol View, Horrel Hill, Fort Jackson, Pontiac, Elgin, Blythewood,
Camden, Richtex, Whitehall, White Rock, Sumter, Lugoff, Boykin,
Rembert, Hagood, Horatio, Stateburg, Borden, Wedgefield, Oswego,
Gadsden, Fort Motte, St. Matthews, Swansea, Woodford,
Winnsboro, Pelion, Steedman, Samaria, Monetta, Batesburg
Leesville, Stoney Hill, Prosperity, Newberry, Peak, Little Mountain,
Slighs, Pomaria, Jenkinsville, Rion, Winnsboro Mills, Simpson,
Smallwood, Ridgeway, Orangeburg, Lexington County, Fairfield
County, Calhoun County, Sumter County, Kershaw County, Saluda
County, and Richland County, SC. We can also offer an inexpensive
South Carolina worker comp insurance quote to your small business
located anywhere in the Palmetto state, including in Florence,
Greenville, Spartanburg, Myrtle Beach, and Charleston, SC.
South Carolina Business Information:
Your South Carolina
Workers Compensation
Insurance Quote Source
Russell-Massey & Co.
1320 Elmwood Avenue
Columbia, SC 29201
Richland County, SC
Toll Free: (800) 849-7475
Office: (803) 779-7854
Fax: (803) 799-6546
Russell-Massey & Co.
409 Lexington Avenue
Chapin, SC 29036
Lexington County, SC
Office: (803) 941-3650
Fax: (803) 941-3654
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Serving South Carolina Since 1955
Richland County & Lexington County, SC Area