Following the instructions on each page will dynamically generate a Workers' Compensation Experience Modifier History Authorization Letter and display it onscreen for you to print on your Company Letterhead.
10700 N. Freeway  Suite 300  Houston, TX 77037  (800) 833-0188		Step 1:  Company Information / Authorizing Officer Information       Company Name:   Federal Tax ID #:         Company Officer Name:   Company Officer Title: