Please use this form to request a physical copy of the 2021 workers' compensation rate card for Pennsylvania. If you have any questions or trouble completing the form, please email Lexi Seitchik at seitchike@whiteandwilliams.com.

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* 1. Name (First and Last)

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* 2. Company/Organization

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* 3. Mailing Address

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* 4. Email Address

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* 5. Questions/Comments

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