Continental Insurance Services Inc.
Office: 504-340-0366
customerservice@contins.com





























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To find out how we can improve your insurance programs, please give us the following information. Be sure to answer the questions as thoroughly and accurately as you can. Please note: Your privacy is in our respectful care. We will share only the information needed with our preferred insurance carriers for quote processing only on a confidential, one-on-one basis.

Please fill out the following information so we may provide you with a free consultation.

First Name
Last Name
Title
Company
Address
City
State
Zip
Telephone
Fax
E-Mail
Please Confirm E-Mail:
Web Page
Federal ID Number
Current Workers Comp Carrier
Number of Employees
Experience Mod. YES?   % 
Please list the annual payroll for each employee workers comp class code.
Claim History (Last 4 years)


We will search the current marketplace for available rating programs, as well as proven WC carriers to bring you the most up-to-date, cost effective program for your particular business.
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