Effective Date

MM

DD

YYYY

Type of Business *

Corporation

Partnership

Sole Proprietorship

LLC

Contact Name *

First Name

Last Name

Phone *

(###)

###

####

Are you an Association Member? *

YES - National

YES - State

NO

Facility Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Was it originally designed for self-storage? *

YES

NO

Facility Construction: *

Frame

Modified/Semi Fire Resistive

Metal/Non-Combustible

Masonry

Other

Controlled Gate Access? *

YES

NO

Automatic Sprinkler System on entire property? *

YES

NO

Does Manager reside on premises? *

YES

NO

Any non-storage operations on site? *

YES

NO

Person Completing this Online Form – Please Select: *

Business Owner

Insurance Broker - Please fill out Agency Information below

Agent Name:

First Name

Last Name

Phone

(###)

###

####

Agency Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country