Please use this form to submit changes to your contact information, address, locations, phone numbers, etc.
To help CMI serve you better, please fill in the necessary fields with your new information.

Step 1
Please give us your name and email address, along with your company's policy number and your risk number if applicable.

Your Name:		Your Email:
Policy Number:

Step 2
Enter the information for your primary location (i.e. Parent Company)

Company Name:		Doing Business As (DBA):
Address:		Address 2:
County:		City:
State:		Zip Code:
Phone Number:		Fax Number:
Claims Contact:		Claims Email:
Financial Contact:		Financail Email:
Safety/Health Contact:		Safety/Health Email:

Step 3
If you have multiple locations, please fill out the necessary fields for each location below. If the location has a different policy please include that also.

Location 2:		Policy Number:
Company Name:		DBA:
Address:		Address 2:
City:		County:
State:		Zip Code:
Phone Number:		Fax Number:
Claims Contact:		Claims Email:
Financial Contact:		Financial Email:
Safety/Health Contact:		Safety/Health Email:

Location 3:		Policy Number:
Company Name:		DBA:
Address:		Address 2:
City:		County:
State:		Zip Code:
Phone Number:		Fax Number:
Claims Contact:		Claims Email:
Financial Contact:		Financial Email:
Safety/Health Contact:		Safety/Health Email: