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Self Storage Quote Form
1. Name Business:
Name Owner:
E-Mail Address:
2. Address / Zip:
3. Bus. Phone / Fax / Home:
Company Name (not agent):
Current Policy Number:
Expiration Date:
Number of buildings:
In City Limits?:
Exterior Walls:
>
Wood
Steel or Metal
Masonry
Ceiling Joists:
>
Steel or Metal
Wood
Masonry
Roof:
>
Metal
Compostion Shingle
Tar & Gravel
Sprinkled:
>
Yes
No
Year Built:
Total Square Ft of all buildings:
9. Annual Rental Income:
(based on 100% occ.)
Replacement Values: All buildings:
Business Personal Property:
10. Responding Fire dept.:
# of miles from F.D.:
12. Claims History last 5 years-Date of Loss:
13. Amount Paid & Description of occurance:
In Stock:
0
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