Metalworking Industries of Michigan

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YOUR NAME:
COMPANY NAME:
BUSINESS ADDRESS:
CITY:
STATE:
ZIP:
WORK PHONE:
HOME PHONE:
FAX:
EMAIL:
CURRENT POLICY RENEWAL DATE:
CURRENT ANNUAL PREMIUM:
EXPERIENCE MODIFICATION FACTOR:

W.C. CLASSIFICATION CODE(S) OF OPERATIONS:	ESTIMATED PAYROLL FOR EACH CODE:

METALWORKING INDUSTRIES OF MICHIGAN

Phone: 1-248-538-0680
Fax: 1-248-538-0471
TOLL-FREE: 1-877-MIM FUND (1-877-646-3863)
Email: info@mimfund.com

ADDRESS: 30600 Northwestern Highway
Suite 250
P.O. Box 3355
Farmington Hills, MI 48333-3355