Midwest Insurance Corporation
Vondracek - Hotz
| First We Will Be Best h Then We Will Be First | ||
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Midwest Insurance Corporation |
Richardson - Hanson |
Vondracek - Hotz |
| Insurance Professionals Serving You for Over 25 Years | ||
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MAKE A CLAIM Please respond with as much information as you have! |
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Contact Ros, our claims specialist, at 515-382-3145 or 800-729-4341. |
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| Or email MIC Group Insurance Agencies. | |
| Insured Name | |
| Insured Address | |
| Insured Home Phone # | |
| Insured Work Phone # | |
| Insured Email | |
| Policy Number | |
| Date and Time of Loss | |
| Location | |
| Injuries Sustained? | |
| Claimant Information | |
| Authority Called? | Yes - No |
| Autos Involved? | |
| Condition of Vehicles? | |
| Where was vehicle towed? | |
| Witnesses Present | Please List: |
| Any Additional Information | |
| Best source of contact communication | |