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MobileStorageInsurance.com - '+header+'


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MobileStorageInsurance.com - Insurance Application

Please complete the following application and fax it to 888-893-8846.

*=Required Field

Policy Effective Date


* Month:                          *Day:                          *Year:

Insured - Owner of Goods Information

* First Name:                                                    MI:                          Last Name:

* Street Address:                                                                                                                                  Apt/Unit #

* City:                                                   * State:                                               * Zip/Postal Code:

Billing Address (if different than above)


* Street Address:                                                                                                                                  Apt/Unit #

* City:                                                   * State:                                               * Zip/Postal Code:

* Phone :                                                   Mobile Phone:

Work Phone :                                                   Email Address:

Details of Goods


* Total Number of units:                             * Unit ID #(s)                                               

* Insurance period (please enter number of months):                             Month(s)

* Coverage amount per Unit 1: USD:

* Coverage amount per Unit 2 (optional): USD:

* Coverage amount per Unit 3 (optional): USD:

* Coverage amount per Unit 4 (optional): USD:

* Coverage amount per Unit 5 (optional): USD:

List Of High Value Items (over $2,500 per individual item) and/or indicate any comments:

 

 

 

 

 

 

Facility Information


* Facility Name:                                                      * Contact Person:

* Phone Number:                                                      Fax Number:

* City:                                                   * State:                                               * Zip/Postal Code:

I ,                                                                               certify that the above information is true and complete.

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MobileStorageInsurance.com - Quick Quote

To receive a QuickQuote© for your Mobile Storage Insurance needs, please complete the following form and fax it to 888-893-8846.

*=Required Field

* First Name:                                                    MI:                          *  Last Name:

* Phone Number:                                                   *  Email Address:

* Effective Date:      Month:                          *Day:                          *Year:

* Facility Name: 

* City: 

  County: 

* State: 

* Total amount to be insured: 

* Insurance period (total number of months): 

* Type of goods to be insured: 

* How did you hear about us (Please circle One)?:     Online Search          Family/Friend Referral

  Repeat Customer          Self Storage Facility         Moving Company         Real Estate Broker         

  Insurance Broker          Mortgage Broker         Newspaper/Magazine         Tradeshow       Brochure

  Other:     Please specify:

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MobileStorageInsurance.com - Claims Form

Please complete the following form and fax it to 636-467-5126. You will be contacted by our claims department within 3-5 business days.

*=Required Field

Owner of Goods

* Mobile Storage Insurance Customer ID #:

* First Name:                                                    MI:                          Last Name:

* Phone :                                                   Mobile Phone:

* Email Address:

* Street Address:                                                                                                                                  Apt/Unit #

* City:                                                   * State:                                               * Zip/Postal Code:

Storage Facility Details

* Name of Facility :

* Street Address :

* City:                                                   * State:                                               * Zip/Postal Code:

* Contact Person:

* Phone Number:

* Fax Number:

* Email Address:

* Storage Unit(s) number(s):

Nature of Claim

* Amount Claimed:                                                      Date of Loss:

* Was a Police report filed?:            Yes / No

* Please describe the loss or damage to your belongings:

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MobileStorageInsurance.com - Join Our Network

To receive a QuickQuote© for your Mobile Storage Insurance needs, please complete the following form and fax it to 888-893-8846.

*=Required Field

* Name of location : 

* Do you own/Manage other facilities?            Yes /       No

If Yes, please complete a separate application for each location you will require insurance for.

* Name of facility owner or manager:  

* Street Address :

* City:                                                   *County:                                         * State:          * Zip/Postal Code:

* Phone :                                                   Fax:

* Email Address:                                                   Web Address:

* Month and Year company established:

* How long has current management operated this location:

* Please explain if less than 12 months:

 

 

 

 

 

Mobile Storage

* Do you Operate a Mobile Storage business at this facility?            Yes /       No

If Yes, please answer the following:

* How many containers/vaults are in your facility at any given month?

* What are the vaults made of?            Metal           Wood           Other

* How many trucks do you operate:

* How many fork lifts do you operate?

Description of Premises

* How many stories?

* Total area (or cubic capacity) of premises available for storage?

* Any basement(s)?            Yes /       No

* If "Yes" is the basement(s) protected by automatic sump pump ?            Yes /       No

Construction of walls?

* Indoor:                                                   Outdoor:

* Construction of Roof :

 

 

 

 

 

* Year built?

* If recently remodeled, when?

* Is the facility located within 5 miles of a flood zone?            Yes /      No

PROTECTION OF PREMISES

* Are sprinklers installed?            Yes /      No

* If “Yes”, please describe:

 

 

 

 

 

* sprinklers type?            Wet           Dry          

* How often serviced?            Monthly           Quarterly           Annually           Bi Annually           Other

* Please indicate last service date:

* Is system equipped with a Sprinkler Alarm?            Yes /    No

* Are security cameras installed?            Yes /    No

* List any other private fire protection:

 

 

 

 

 

* Are the premises protected by a fence?            Yes /    No

* Is security lighting installed?            Yes /    No

* Premises protected by an Alarm System?            Yes /    No

* Alarm Type?            Central           Local

* Name of Protective Company:

* Any Biometric protection system?            Yes /    No

* If "Yes" Describe:

 

 

 

 

 

* Total number of employees:

* If any employee(s) bonded, give details:

 

 

 

 

 

* Is there a Live-in manager on premises?            Yes /    No

* Name trade associations in which membership is held:

 

 

 

 

 

Online Search                                    Solicitation Call                                               

Insurance Broker                              Newspaper/Magazine                                               

Moving Company                              Brochure                                               

Insurance Broker                            

If other, please specify: 

* Date:                                                                 Name:

* Position:                                                   Signature:

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