In Transit. In Storage. Insurance

StorageInsurance.com - Claims Form

Please complete the following form and submit. You will be contacted by our claims department within 3-5 business days.
*=Required Field

To fax this form Print this page and fax it to 973-528-0641.

Owner of Goods

*Storage Insurance Customer ID#		Missing Customer ID
*First Name Missing First Name	MI	*Last Name Missing Last Name
*Phone Missing Phone Number		Mobile Phone
*Email Address Missing Email AddressNot a valid e-mail address format
*Street Missing Street Name		Appt/Unit #
*City Missing City Name	*State: Missing State	*Zip/Postal Code Missing Postal/Zip Code

Storage Facility Details

*Name of Facility Missing Facility Name
*Street Address Missing Facility Street Address
*City Missing Facility City Name	*State Missing Facility State	*Zip/Postal Code Missing Facility Zip/Postal Code
Contact Person
*Phone Number Missing Facility Phone Number	*Fax Number Missing Facility Fax Number
Email
*Storage Unit(s) number Missing Storage Unit(s) number

Nature of Claim

*Amount Claimed:	Missing Amount Claimed
*Date Of Loss:	Missing Date of Loss

*Was a police report filed?:

Yes

*Please describe the loss or damage to your belongings: