Storage Facility Request Form
Company Information
Company Name		Address
City		State
Zip		Phone
Fax		E-Mail
Contact Name
Insured Information
Name		Street Address
City		State
Zip		D.O.B.
D.L.#		SS#
Work Phone		Home Phone
Cell Phone		Pager
Location Information
Name of Facility		Address
City		State
Zip		Phone
Property Manager
Claim Information
Claim #		Date of Loss
Due Date
Assignment:	Field Interview and Photographs Telephone Interview Other
Description of Loss
Notes/Special Instructions
Additional Information