Your First Name (Required)
Your Last Name (Required)
Street Address (Required)
Suite/Apt #
City (Required)
State (Required)
AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming
Zip/Postal Code (Required)
Residential Phone # (Required)
Cell Phone #
Email Address
Policy – First Name
Policy – Last Name
Storage Unit Number (Required)
Self Storage Facility Name (Required)
Self Storage Facility City
Self Storage Facility State
Self Storage Facility Phone Number
Application/Certificate Number (Optional)
Remarks
Date of Loss (MM/DD/YYYY)
Time of Loss
Police or Fire Dept Reported To (optional, if applicable)
Probable Amount of Entire Loss
Loss Type FireWindFloodTheftHailLightningOther
Description of Loss and Damage
Email photos to StorageClaims@AmericanNational.com or upload photo.