Click here for home page of Midwest Technical Inspections   Midwest Technical Inspections

Automated Ordering Options

Completed reports may be retrieved from: GISA Global System Access




        Save Values

Premium Audit Services: order here with your login. Survey Descriptions

If you need assistance, please contact your Account Manager or 800.451.5621 and we will be happy to assist you.


Please be sure the account code you enter is correct!
(* indicates required fields.)

*Account Code:
Company Name:
*Policy Number:
Agency:
Agency Phone:

Send Report to:
E-mail Address:
------------Coverage Amounts------------
Building: $
Contents: $
Type of Business:

Contact Person Placing This Order - Your Telephone # & Ext. (in case we have a question):


Insured / Mailing Address

 
 

*Name (Last Name, First):
Contact/DBA:
*Address:

*City: *State:
*Zip Code: Phone:

Survey Address
(If Different from Mailing Address)


Address:

City: State:
Zip Code: Phone:


Vehicle & Driver Information (vehicle surveys only)

Veh #1 Description:
Veh #2 Description:
Veh #3 Description:

Veh #1 Class:
Veh #2 Class:
Veh #3 Class:

Driver's Name

Birth Date
(Date Format MM/DD/YY)

Driver's License Number

1:
2:
3:

Insurance Survey(s)If you need something which is not listed, please give us a call 800.451.5621 and we will be happy to help! Requested

Global Telephone Surveys Survey Descriptions


Commercial Lines Surveys - Hourly Survey Descriptions


Abbreviated Commercial Lines Surveys - Published Rates Survey Descriptions


Limited Commercial Lines Surveys - Flat Rates (appropriate for Surplus Lines) Survey Descriptions


Farm Surveys - Hourly & Published Rates Survey Descriptions


Personal Lines Surveys Survey Descriptions


Premium Audit Services Survey Descriptions


Photographs Requested

Front / Side View

Rear / Side View

Special Hazards

Comments / Special Instructions

(Maximum 800 Characters)


Please "Send Order" after each request.

A "Confirmation" screen will indicate a successful transmission.