Commercial Property/Equipment Change Request

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Please fill out the following Commercial Property/Equipment Change Request form. Please note that any changes will NOT be in effect until you receive confirmation from our office.

*Required Fields

Property/Equipment Change Request Form
Insured Information
*Name
Address
City
State
Zip
*Email
*Phone

Type of Change
*Change Type


Property/Equipment Information
Property/Equipment Address
Property/Equipment City
Property/Equipment State
Property/Equipment Zip

Description of Property/Equipment


Property/Equipment Value


Loss Payee Information
Name
Address
City
State
Zip

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Scott Umland Insurance Services, LLC

2028 Jackson Street

P. O. Box 236

New Holstein, WI 53061

Phone: (920) 898-5755