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    Requestor Information

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    Policy 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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    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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