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