Filling in the Employer Application

  
  The link below will take you to the employer application.  It is an "Adobe Acrobat" pdf form that you can fill in and print.  Or, you can print the blank form out and fill it in manually.  The Adobe software makes it very clear that you can't save the form with the data filled in (you can do this if you have the "Professional version of the software).  Either way, you should sign the form and then do one of the following:

1.  Fax the signed form to the Insure Montana Program at (406) 444-3497

2.  Print and sign the form and then scan and email it to the Insure Montana Program at            insuremt@mt.gov

3.  Mail the signed form to the Insure Montana Program at  

Insure Montana

840 Helena Avenue

Helena, Montana  59601

 

Insure Montana Employer Application

You'll need Acrobat Reader on your PC to view and fill the downloadable file on this page.  Click on the following icon to download the latest free version.