coshare logo

MEMBER INSURANCE PROGRAM

Workers Compensation 
Insurance Quote Request Form          


Please complete and submit the following form to request Coshare member workers compensation insurance quotes.  Once submitted, a member of our Coshare member insurance benefit team will contact you to discuss your specific needs and provide a custom quote.

  • Yes
  • No
  • Yes
  • No
  • Yes
  • No
  • N/A
  • Yes
  • No
  • Yes
  • No
  • Yes
  • No
  • Yes
  • No

Type the words you see above separated by a space.
Letters ARE case-sensitive.

Quotes are provided by licensed agents with the Nicholas Hill Group, Inc.  Quotes are subject to full underwriting and include certain exclusions and limitations.  Not all products are available in all states.  Please contact the Nicholas Hill Group, Inc. with any coverage questions or concerns by calling 1-877-303-2050 or emailing info@nicholashillgroup.com.