Commercial/Medical Move Form - American Benefits Insurance | Portland, Oregon

Directions:

1. To expedite processing, please download and complete the ABI New Location/New Building Questionnaire then either email it to your agent or fax to 503-467-4600 .

Or:

2. Please complete the form below and click on the SUBMIT button. (Attachment of questionairre not required for submission.)

Name Insured*
First Last
Policy Number*
Name of Business or Association*
Address*
Street Address Address Line 2 City State ZIP Code
Unit (optional)
Email*
Phone*
Fax
Person Making Notification*
First Last
Person's Phone*
Person's Email*
Special Instructions
Preferred method of contact?*
- E-mail
- Phone
- Fax
- US Mail
Phone
This field is for validation purposes and should be left unchanged.