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Self-Storage Insurance Quote Form
First & Last Name:
Street Address:
City, State & Zip:
E-Mail Address:
Telephone:
Fax:
Current Insurance Information
Insurance Company Name:
Policy Exp. Date:
Amount Insured for:
Mortgage Amt:
Premium Amt:
Term:
Any Claims in Last 3 years?
# of Buildings:
In City Limits?:
Exterior Walls:
Select..
Wood
Steel or metal
Masonry
Ceiling Joists:
Select..
Wood
Steel or Metal
Masonry
Roof:
Select
Metal
Comp. Shingle
Tar & Gravel
Sprinklered:
Yes
No
Year built:
Sq. ft. of buildings:
Annual Rental Income (based on 100% occ.)
Replacement Values of all buildings ($):
Replacement Value Business personal property:
# of miles from fire dept:
Claims History of last 5 years:
Give any additional information that may assist us in providing you with an accurate self-storage insurance quote:
