This is not an application for enrollment.
Signing this release gives BIAW permission to contact anyone at the above listed company via mail, email, and phone for any BIAW-related matters.
You are hereby authorized to provide our company's premium, claims history, losses, statistics, experience modification factor, and related industrial data, including all sub-accounts tied to the policy whether inactive or active, to the Building Industry Association of Washington along with access to the Department's online Claim & Account Center.
Please sign the box using your mouse, finger, or stylus. We will notify you by email when we receive your submission.