|
If you would like for us to provide a lender or mortgage
company with a document outlining the insurance coverage you have
on a particular building, home or dwelling, vehicle, piece of equipment,
or piece of property, please complete and submit the form below.
|
| Evidence of Property Insurance Request
Form |
|
|
|
|
Your Name or Company Name:
|
|
|
Your E-mail Address:
|
|
|
Please click the item which this
request is for:
|
|
| If the request is for a Building,
Home or Dwelling please list the location address: |
|
Address:
|
|
|
City:
|
|
|
State:
|
|
|
Zip:
|
|
| If the request is for a vehicle please
complete the following: |
|
Year:
|
|
|
Make:
|
|
|
Model:
|
|
|
VIN:
|
|
| If the request is for a piece of equipment
(computers, copy machines, phones, contractor's equipment, etc.) please
complete the following: |
|
Year:
|
|
|
Mfg:
|
|
|
Description:
|
|
|
Model:
|
|
|
Serial Number:
|
|
| If there are other pieces of equipment
to which this lending company or bank is to be added as a loss payee,
please describe below: |
|
|
| If the request is for other property
please specify: |
|
|
|
Loan Number (if known):
|
|
| Information regarding the Lending
company or Bank: |
|
Name of Lender/Bank:
|
|
|
Attention:
|
|
|
Mailing Address:
|
|
City:
|
|
|
State:
|
|
|
Zip Code:
|
|
|
Is this a new Lender or Bank?
|
Yes
No |
|
If you checked "NO", does this
represent just an address change to the lender?
|
Yes
No |
|
If you checked "Yes" to the first
question, should we remove the previous lender?
|
Yes
No |
|
Do you want a copy of this evidence
sent to you as well as the lender?
|
Yes
No |
|
How do you want the evidence sent
to the lender?
|
Faxed
Mailed |
|
If you answered "FAXED", to what
fax number shall the evidence be sent:
|
|
|
Disclaimer:
Coverage cannot be bound by
use of this system. If you have new property to be added to your
insurance policy or if you wish to make any changes whatsover, you
can communicate your wishes to us electronically, but coverage cannot
be considered bound or modified until you have received verbal,
written or electronic confirmation of such addition or change.
|
| |
|
