How can we help you?

Are you a current client of our agency?*
- Yes
- No
What policy number(s) do you need help with if available?
What is the nature of your inquiry?*
- General Question
- ID Card Request
- Policy Change Request
- Discuss A Claim
- Certificate of Insurance
Describe your policy change request
What date do you need this policy change/request to take effect?*
DD slash MM slash YYYY
Which vehicle do you need an ID card for (please enter year, make, and model)?
Year Make Model
Your Name*
First Last
Your Email*
Your Phone*
Please list the Additional Insured and/or Certificate Holder
Additional Insured and/or Certificate Holder Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Details regarding your question, policy change, claim or other request:*
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Dan M Weier Agency

203 Grand Ave
#102
Lake Villa, IL 60046

(847) 356-6400

Opening Hours

Monday 8:30 am – 6:00 pm

Tuesday 8:30 am – 6:00 pm

Wednesday 8:30 am – 6:00 pm

Thursday 8:30 am – 6:00 pm

Friday 8:30 am – 6:00 pm

Saturday 9:30 am – 12:00 pm

Sunday Closed

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Year	Make	Model