CompIQ Corp   

Workers' Comp Bill Audit Referral Form

Print this form and use it as a fax cover sheet for your bill and fax to 949-770-7428. 
or Print this form and mail it along with your bill to... CompIQ Corp, Attn: IQAudit,  2 South Pointe, Suite100, Lake Forest, CA, 92630. 
or Submit this form and mail your bill to... CompIQ Corp, Attn: IQAudit,  2 South Pointe, Suite100, Lake Forest, CA, 92630. 

Your Company:  Claim Number:
Contact Person:  Company File No.: 
Address:   
Jurisdiction State:    
Phone Number: Fax Number:
E-mail:  
Special Handling Instructions:
Time deadline, prior negotiations, special billing instruction, etc.

  

Mail Completed Form and Bill to...
CompIQ Corp
Attn: IQAudit
2 South Pointe, Suite 100
Lake Forest, CA 92630

Fax Completed Form and Bill to...
949-770-7828
Attn: IQAudit

Phone: 949-770-7828  ext 11

2 South Pointe, Suite 100, Lake Forest, CA 92630
tel  949-770-7828      fax  949-770-7428