QUOTE REQUEST
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info@hudsonpublicrisk.com
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770-727-7200
Solutions
Risk Management Portal
Client Services
Solutions
Risk Management Portal
Client Services
Equipment Update Request
Equipment / Trailer Change Request
Requestor Name
(Required)
Phone
(Required)
Email
(Required)
Insured Name
(Required)
Change Effective Date
(Required)
MM slash DD slash YYYY
DOT# (If applicable)
Do you want to add or remove equipment or machinery?
Yes
No
Equipment / Machinery Information
(Required)
Add/Remove
Year
Make
Model
Value
17 Digit VIN Number
Serial Number
Add/Remove
Add
Remove
Year
Make
Model
Value
17 Digit VIN Number
Serial Number
+
−
Do you want to add or remove a trailer?
Yes
No
Trailer Equipment Information
(Required)
Add/Remove
Year
Make
Trailer Type
Value
17 Digit VIN Number
Add/Remove
Add
Remove
Year
Make
Trailer Type
Value
17 Digit VIN Number
+
−
For Trailers, please specify if Dry Van, Reefer, Flat Bed, etc. in the type field.
Additional Interest:
Additional Interest:
Last 4 of VIN #
Additional Interest Name
Street Address
City
State
Zip Code
Interest Type
Last 4 of VIN #
Additional Interest Name
Street Address
City
State
Zip Code
Interest Type
Loss Payee
Additional Insured
Lien Holder
Leasing Agent
+
−
Interest Type: Loss Payee, Additional Insured, Lien Holder, Leasing Agent.
Comments:
