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Coverage Cancellation Request
Please complete the form below.
Direct Phone Number
Item or Serial #
Reason for removal
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You may attach a supporting document with your request.
Equipment Cancellation Date
I have read and agree to the following:
I have read and agree
The Requestor above is authorized to make changes to equipment coverage options. All accepted changes made to the Schedule of Covered Equipment will be bound by a written modification to the Agreement issued by Remi. Remi is not liable for any loss or return of the Agreement Amount associated with unauthorized changes to the Schedule of Covered Equipment.