Request For Business Transfer Information {BWC-0504}

BWC-0504 / AC-4 - REQUEST FOR BUSINESS TRANSFER INFORMATION. Use this form to obtain information from BWC concerning (1) the rates to be applied where one employer takes over the occupation or industry of another, and (2) the portion of the account assumed by the successor in interest. The release must be signed by the employer that may be transferred in whole or in part, as well as the employer that may acquire the transferred business. The release must be validated by BWC, and a copy produced by the employer or its representative requesting business transfer information. Submit the form to BWC by either email, fax, or mail. www.FormsWorkflow.com