Evidence Of Property Insurance Request Form If the evidence of insurance is related to a Vehicle you or your company owns or leases, please click here. Information regarding the Vehicle: Year Make Model Loan Number (if known) Information regarding the Lending company or Bank: Name of Lender Attention Mailing Address City State  Zip - Is this a new lender on this vehicle? YES NO If you checked "NO", does this represent just   an address change for the lender? YES NO If you checked "YES", 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 Do you you want the evidence FAXED or MAILED to the lender? If you answered "FAXED", to what fax number shall the evidence be sent: - - If the evidence of insurance is related to a piece of EQUIPMENT (computers, copy machines, contractor's equipment, etc.), please click here. Information regarding the piece(s) of equipment: Year Manufacturer Description Model Serial Number Click HERE if there are other pieces of equipment to which this lending company or bank is to be added as a loss payee. DISCLAIMER: COVERAGE CANNOT BE BOUND ON ANY EQUIPMENT BY USE OF THIS SYSTEM. IF YOU HAVE NEW PIECES TO BE ADDED TO YOUR INSURANCE POLICY OR IF YOU WISH TO MAKE ANY CHANGES WHATSOEVER, 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.