To cancel coverage, please complete the form.

    Requestor Information





    Policy Details

    Equipment Details


    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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