Insurance Request Form

 

Please fill out the below form or print and fax to 905-874-9265:

REQUEST FOR INSURANCE COVERAGE:

Attention:     
              Date:
Fax:
Company Name

OPTION #1

The standard insurance coverage supplied by Quality Moving & Installations Inc. is set at a fixed rate of $0.60 per pound per article.

AUTHORIZED SIGNATURE:

OPTION #2

Additional insurance can be purchased at a fixed rate of  $6.00 per $ 1000.00 of declared value of items to be insured.

Declared Value of Items:

(Please enclose an itemized list of items to be additionally insured)

Total Additional Insurance Required:

( Declared Value x $6.00 divided by $1000.00)

AUTHORIZED SIGNATURE:

 

Home ] Our Services ] Responsibilities ] Request a Quote ] Insurance Coverage ] Relocation Tips ] Employment ] Contact Page ]

Send mail to services@thenetminders.com with questions or comments about this web site.

ml> >