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You may just want to change agents - Check with us before you buy or renew!

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Low Cost
Insurance for
North Carolina
Residents!


Call Us for a
RUSH Quote.
We can place
Coverage
INSTANTLY!

 
Or, Get A FREE
Quote On-Line

 
 
Auto Insurance
"D.W.I." Insurance
Antique & Classic Car
Cycle & 4 Wheeler
Homeowners
Builder's Risk
Modular/MobileHome
Businessowners
Worker's Comp
Commercial Auto
Contractor Liability
Recreational Vehicle
Boat Insurance
Life Insurance
Short Term Health
Hospital Insurance
Medicare Supplements
Disability Insurance

 
Contact Us
 
 
E-Mail:
apbenfield@aol.com

Phone:
Toll Free:
1-866-632-6458
Direct Line:
1-828-632-6505

Fax:
1-828-632-0172

Mailing Address:
78 East Main
Avenue
Taylorsville,
NC 28681

Insurance
License #:

237-68-0393

Meet Our Staff!


For Your
Convenience,
We Accept:

Don't forget to ask about our "10+10" Insurance Discount! That's 10% off your Home and Auto Insurance when we write both policies. DOUBLE Your Discounts NOW!

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On-Line Workers
Compensation Quote Form
One Simple Form - takes only 2-3 Minutes!


Your Personal / Company Data:

Your Name:
Your Company's Name:
Street Address:
City:
State: (Must be North Carolina)
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again (for accuracy):
Phone:
Fax (optional):
 


Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type NONE)
 
List Claims & Amounts Paid
(If none, type NONE)
 
Years In Business:
 
Business type:
(proprietorship, corporation, etc.)
 


 
Underwriting Information:
 
Describe IN DETAIL,
Your Business Operations:
 
Payroll Class #1:
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here:
$
 
Payroll Class #2: (if none, leave blank)
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here:
$
 
Payroll Class #3: (if none, leave blank)
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here:
$
 
 
Send my quotation via: E-Mail Fax
Regular Mail

 
Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a
Workers Compensation Quote NOW!


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Terms of Use/Privacy Notice/Copyright Info. No. Carolina Insurance Online since: September 2,000.
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