Call: (515) 226-9600

Utility Claim Form – Online

Utility Claim Form

Please completely fill out form below to submit claim.
* = Required Fields

Please attach all necessary files below.
Maximum 10MB per attachment.

Please inform this office of any activity concerning this claim.

We have accepted this assignment on a contingent basis and will full settlement authority. Our consultant/settlement fee will be 50% of the reduction in liability.
Settlement of utilities damage claims can be compared to subrogation/recovery and may take an abnormal length of time to resolve.

I Have Read and Accept the terms above.


Mid America Company
2900 Justin Dr, Suite I
Urbandale, IA 50322
Phone: (515) 226-9600
Fax: (515) 226-9600

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