WCRB Business Contact Form

Carriers submit this form to designate or change an existing primary contact name/mailing address for all Financial communications, hard copy Underwriting communications and hard copy Unit Stat communications.

When this form is successfully submitted, the requestor email address will receive an emailed receipt confirmation.

If you have any questions regarding the use of this form, please contact WCRB via email at industry.support@wcrb.org or by phone at (262) 796-4540.

Select one or more of the following notifications:

Select at least one notification preference

Financial (Assessments/Invoices)UnderwritingUnit Stat

Member Information

Carrier ID (NCCI #):

Carrier Name:

Requestor Information

Carrier Authorizing Representative Name: Contact name required

Carrier Representative Title: Contact title required

Carrier Representative Phone#: () - Phone area code required Valid area code required Phone prefix required Valid prefix required Phone suffix required Valid suffix required

Carrier Representative Email Address: Invalid Email address Email required

Financial (Assessments/Invoices)

Not selected

Underwriting

Not selected

Unit Stat

Not selected