Mobile Equipment Registration

Mobile equipment Identification fields marked with * are required and fields marked with ** are required only if adding mobile equipment (Add is chosen in Policy Change field). As an alternative, you may also download this form in an adobe document format, fill it out, and either fax it to (916)774-7040 or email it to the Member Services Department.

    Mobile Equipment Information
    * Policy Change
    * District
    ** Date Aquired Unit Number
    * Equipment Year * Manufacturer
    * Model * Description
    * Equipment Serial Number ** Estimated Value
    Please list all accessories below. Including, Buckets, Scrapers, etc.
    Accessories
    ** Capacity of Equipment
    (Cubic Yards, KW, GPM, CFM, etc.)
    ** Lease or Financed YesNo ** Permanently Mounted to Licensed Trailer  YesNo
    Contact Information
    * First Name * Last Name
    * Email
      

    Mobile equipment Identification fields marked with * are required and fields marked with ** are required only if adding mobile equipment (Add is chosen in Policy Change field). As an alternative, you may also download this form in an adobe document format, fill it out, and either fax it to (916)774-7040 or email it to the Member Services Department.

      Mobile Equipment Information
      * Policy Change
      * District
      ** Date Aquired Unit Number
      * Equipment Year * Manufacturer
      * Model * Description
      * Equipment Serial Number ** Estimated Value
      Please list all accessories below. Including, Buckets, Scrapers, etc.
      Accessories
      ** Capacity of Equipment
      (Cubic Yards, KW, GPM, CFM, etc.)
      ** Lease or Financed YesNo ** Permanently Mounted to Licensed Trailer  YesNo
      Contact Information
      * First Name * Last Name
      * Email