Agent Registration
Workers Comp Solutions
1445 Mac Arthur Drive
Suite 228
Carrollton, TX 75007
Phone 877.223.7672 ext: 709
become_an_agent
contact informationcompany information
first name*
last name*
email*
phone*
address
city
state
zip
company name
annual payroll
type of business
known losses for
the last three years
more details
Type each of the following letters into the box below.
  
*indicates required field
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