To cancel coverage, please complete the form.
Name:*
Title:*
Direct Phone:*
Email:*
Account Name:
Policy #:
Item or Serial #:*
Manufacturer:
Type of Equipment:
Reason for Removal: *
You may attach a supporting document with your request.
Equipment Cancellation Date:
I have read and agree to the following:
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.
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Upload your current electronic equipment service agreements and let us provide you with an alternative quote. If we offer similar coverage for less, consider us.
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