Policy Change Request


Life happens.  Make sure your policy coverage keeps up with you.


Call us for immediate assistance

No changes will be made to your policy unless we speak directly with you, in person or by phone, to confirm the requested changes.

Request a Change to Your Policy

Feel free to get the process started by alerting us to changes using this form. We'll follow up with you within one business day to verify this request.
  • Date Format: MM slash DD slash YYYY
  • NOTE: Changes to your policy will NOT be made until speaking directly with a licensed Bank Midwest Insurance Services representative either by phone or in person. Changes in coverage, new policies and policy cancellations always require contact. We'll be in touch with you. This is for your protection...and ours!