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insure-all

 

 

 

 

 

 

 

 

 

COMMERCIAL INSURANCE
POLICY CHANGE REQUEST

This form is for the use of employees and customers of Hudson & Muma and insure-all.com only.

We at Hudson & Muma/Insure-all.Com believe that it is important to offer our customers the most up-to-date technology available which will enhance the service they receive. It is because of this commitment that we are offering this form to aid in generating accurate applications and forms quickly and efficiently!  

 

SUBMITTING THIS FORM YOU ARE AGREEING TO THE CONDITION THAT NO MATERIAL CHANGE WILL BE MADE TO YOUR POLICY UNLESS AND UNTIL YOU RECEIVE CONFIRMATION OF THAT CHANGE FROM A HUDSON & MUMA ASSOCIATE OR AN ASSOCIATE THAT THE INSURANCE COMPANY WRITING THE COVERAGE. 
* Indicates required fields

 

COMMERCIAL POLICY
CHANGE REQUEST

...

Note: Any policy changes will not be effective
until you have confirmation from a Hudson & Muma
associate via phone, fax or email.

ENDORSEMENT (CHANGE)  EFFECTIVE DATE*:  (mm/dd/yyyy)

 CLIENT NAME:*

POLICY INFORMATION

Policy #:
Policy Type: (e.g. package)
Term: (e.g. 2006)


Nature of Change*:



Special Instructions:

ATTACHMENTS:

If you have a document that needs to accompany this
request , e.g. equipment lists, etc.

Attachment 1:
Attachment 2:
Attachment 3:

 


Form Prepared by: (your name)

Change ordered by: (authorized insured) 

Ordered via: (insured)

Confirmation Email Address:
(We need this to send you a confirmation receipt for this form.
See our Privacy Policy HERE)



 

 

 

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Copyright © 1997-2008 Hudson & Muma, Inc.
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GLOSSARY OF INSURANCE TERMS