Request an Equipment Change

 

(Changes will be effective upon confirmation by a King & Neel representative)

Please use your TAB key to move through the form...



(* means required)

 

* Your Business Name

*Your  Name 
*Phone 
 * Email Address 
Fax Number 

 * Effective Date of the Change:

 

Bought  a piece of equipment
Got rid of a piece of equipment
Change to existing equipment
Other (specify below) 

 

Description of the equipment to change:

* Model Year * Make/Model
Type * Serial Number
Insure for $ 

Replacement Cost   Actual Cash Value

 

Description of any parties with Additional Interests:

Is the equipment financed?  YES  NO Is the equipment leased?  YES  NO

If yes, full name and address of the Loss Payee:
(a certificate of insurance will be issued)


If yes, full name and address of the Lessor
(a certificate of insurance will be issued):

OTHER COMMENTS OR REMARKS?

If you would like a copy, please PRINT before hitting "submit".  Thank you!