Contact John John M. Tomlinson  Vice-President Employee Benefits  Mid-State Insurance  7105 W. Mequon Rd.  P.O. Box 550  Mequon, WI 53092  (262)241-0550 phone  (262)241-0515 fax  (414)254-9964 cell  JohnT@midstateis.com Name: * Company: Address:* City:* State:* Zip:* Daytime/Work Phone:* Evening/Home Phone: Email:* Fax: I am interested in more information on: Group Health Individual Health Insurance Group Life, Disability and Dental Coverage Employer Sponsored Long-term Care HSAs/HRAs Multiple Option Plans Association/Chamber of Commerce Health Plans Voluntary Benefits Medicare Plans Domestic Partnership benefits available on some plans

(262) 241-0550 phone | (414) 254-9964 cell | 262-241-0515 fax | JohnT@midstateis.com