Removal of Loss Protection Form

Please complete and sign this form. If you have any questions, you may contact us.

Printable Removal of Loss Protection Form

  • In the event that the Equipment is lost, stolen or damaged in an accident, the Lessee shall pay the sum of $1,995.00 to replace the equipment or necessary repair fees and shall continue to make the monthly payments due as itemized in the original lease agreement.

    The loss protection removal will become effective upon my next payment date after the return of this signed Addendum C.

  • MM slash DD slash YYYY