Miller-Lewis Insurance is here to help you with any changes you have with your policy. You may call our office at 740- 687-6258 to discuss changes with one of our agents or fill out the form below. When a change is made to your policy, a signature is also needed to approve those changes. We can Mail, Email or Fax the papers directly to you for your signature. We can now accept a faxed or electronic signature on these papers as acceptance of changes made.

Please be sure to leave a daytime phone and an Email address so that we can contact you promptly. Please include any questions or concerns that you may have.
 

 


Change of Policy Form:
 

Name:

Phone Number:

Fax (Optional):

Email Address:

Home Address:

City, State and Zip Code

Type of Policy:

Send Papers for signature by:

Mail Fax Email

Description of Change/Questions:

 


 


 

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    121 East Sixth Avenue, Suite 103, Lancaster, Ohio 43130-0368
    Phone: 740-687-6258 or 800-734-3198 / Fax: 740-687-1836
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Email: KentMiller@Miller-Lewis.com