Helpful Forms

Hotel Application

Loss Run Request
Statement of Losses
Incident Report
Witness Statement
Supervisor's Incident Report #1
Supervisor's Incident Report #2
Workman's Comp First Report of Injury Tennessee
Workman's Comp First Report of Injury Georgia
Workman's Comp Corporate Officer Exclusion, Tennessee
Sole Proprietor Workman's Comp Consent Tennessee
Workman's Comp Corporate Officer Exclusion, Georgia
Sole Proprietor Workman's Comp Consent Georgia
Request for Workman's Comp History

 

Insurance Xchange
6125 Preservation Drive
Chattanooga, TN 37416

Stephen F. Holmes, President
Email: steve@eHOSPITALITYinsurance.com
Cell: 423-313-0901
Office: 423-894-0901 Ext. 103

Andrew Stephens, New Business Manager
Email: andrew@eHOSPITALITYinsurance.com
Office: 423-894-0901 Ext. 102
Cell: 423-298-7701

Betty Langley, Office Manager
Email: betty@eHOSPITALITYinsurance.com
Office: 423-894-0901 Ext. 101

Susan Armour, Customer Service
Email: susan@eHOSPITALITYinsurance.com
Office: 423-894-0901

 

 
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