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Acord 130 Workers Compensation Application Template Library

Acord 130 Workers Compensation Application

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Acord 130 Workers Compensation Application

Easily parse data from an Acord 130 Workers Compensation Application form.

Fields include:

• Agency Name

• Agency Address

• Producer

• CS Representative Name

• Agency Office Phone

• Agency Mobile Phone

• Agency Fax

• Agency Email Address

• Code

• Sub Code

• Agency Customer ID

• Company

• Underwriter

• Applicant Name

• Applicant Office Phone

• Applicant Mobile Phone

• Applicant Mailing Address

• Applicant Address

• Yrs in Bus

• SIC

• NAICS

• Website Address

• Applicant email Address

• Sole Proprieter

and many, many more…

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