To cancel coverage, please complete the form.

Requestor Information

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Policy Details

Equipment Details

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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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