Submit an ACORD Application

Please complete the fields below and upload the completed ACORD form. In order to bind coverage, there are specific criteria that must be met. Once the binding criteria are met and the required deposit is received, coverage will be bound within one (1) business day. The deposit premium payment must match the minimum deposit premium. A Travelers representative will call you within one (1) business day to obtain payment of your deposit premium over the phone. If you do not receive a call within one (1) business day, please call us at 800-842-9346.

Step 1: Download and Complete ACORD Application

Complete the PDF form electronically, or alternatively, print, complete, and scan it back in.

ACORD Application Instructions (PDF)

ACORD Application (PDF)

  • ACORD Forms Reminders
  • You will need to have payroll and other information about your business available when filling out the ACORD form.
  • Be sure to complete the following sections of the ACORD form: Federal Employer ID Number, Contact Information, Rating Information, and Signatures. NOTE: An electronic signature is sufficient. An original signed application is not required.
  • Please accurately describe the nature of your business and provide a description of operations.
  • Sole Proprietors and Partners are not covered unless they elect to be covered on the ACORD application (or submit a written request for inclusion).
  • Executive officers of Corporations are considered employees and must be covered if the employer meets the requirement for corporate coverage.
  • Members of Limited Liability Companies are presumed to be covered, unless they formally opt out of coverage; click here for the Rejection of Coverage Form. The signed Rejection of Coverage Form must be provided. Submit the signed form via email to MWCP@travelers.com, fax to 1(844)335-7825, mail to Travelers at PO Box 5600, Hartford, CT 06102-5600, or by uploading a copy as part of the application package.
  • Refer to the Missouri Department of Insurance website for useful tips and information regarding Workers’ Compensation.

Step 2: Fill Out General Information

Is the person completing this form the Policyholder or the Producer?

Step 3: Upload Completed Application

By submitting this online application you understand that no coverage is bound, implied or altered until you receive written confirmation from us that coverage has been bound.