Aniello Insurance Agency
Aniello Insurance Agency
Phone (702) 259-0250 Phone
Send Email Send Email
Send Email
Aniello Insurance Agency
Assurance In Insurance
Trusted Choice(R)
Aniello Insurance Agency
Aniello Insurance Agency
Aniello Insurance Agency
Friend us on facebook, follow us on
twitter, and link us on linked in

Aniello Insurance Agency
Facebook Aniello Insurance Agency Twitter Aniello Insurance Agency LinkedIn
Aniello Insurance Agency
Aniello Insurance Agency
Aniello Insurance Agency
3012 West Charleston Blvd.
Suite 150
Las Vegas, NV 89102
Phone: 702 259-0250
Fax: 702 259-0662

Aniello Insurance Agency Get A Quote
Aniello Insurance Agency
Aniello Insurance Agency
Aniello Insurance Agency

Get A Quote

Workers' Compensation Insurance Quote

We would like to provide you with a free, no-obligation Workers' Compensation insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

General Information
Name of Practice:
Contact Name:
City:   State:   Zip:
Practice Phone:   Fax:
Contact Email Address:

Current Insurance Information
Company Name (not agency):
Policy Expiration Date:   Premium Amount: $
NCCI Number:
NCCI Experience Modification Number:
What type of coverages do you currently have:
Commercial Auto
Commercial Liability
Commercial Property
Commercial Umbrella
Directors & Officers Liability
Group Health
Group Life
Professional Liability

About Your Practice
# of full-time
# of part-time
How long
in practice
How many
Estimated Annual
Please give a brief description of your practice (below):

Additional Practice Information
Do you have any losses in the past 3 years?: Yes No
Do you have Independent Contractors?: Yes No
If yes, how many?:
Do paychecks reflect the above name?: Yes No
If no, please provide details:
Federal Tax td:
Type: Corporation Partnership
Individual    Other
Average hourly wage for non-physician employees: $ / hour
List all Officers/Partners
Name: Title: % Ownership: Excluded/Included:
What is the practice specialty?
Off premise operations: Yes No

Employee Information
Classification code
Estimate Yearly Payroll
Please list additional employees in the "Additional Comments" section below

Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you have
additional information where there was not enough space, please enter them here.

Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.


Online Forms by ENHANCED Web Services
This Workers' Compensation Quote Form Copyright © 1999 - by ENHANCED Web Services

Aniello Insurance Agency

Aniello Insurance Agency
Return Home   |   Insurance Services   |   Get a Quote   |   Customer Service
Aniello Insurance Agency
About Us   |   Links   |   Newsletter   |   Contact Us

Aniello Insurance Agency
Important Note: This website provides only a simplified description of coverages and is not a statement of contract. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.
Aniello Insurance Agency

Copyright © Aniello Insurance Agency. All rights reserved.             Web site development by Enhanced Web Services

Privacy Notice: Your privacy while visiting our website is important to us. Because there are parts of our site where we ask you to provide us with certain types of personal information about yourself, we want you to know how we will use it. We will use the information that you give us explicitly for the purposes stated on any online electronic form on this website, which in most cases will be for quoting, service, and information requests. We will not sell, share, or turn over any information you provide to any other person or organization. We may make it part of a reference source for future contact with you by our organization. We take your privacy very seriously, and ask that you contact us directly if you have any questions or concerns about the use of our website.
Aniello Insurance Agency