Contact Information Your First Name Your Last Name Street Address Ste/Apt # City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming Zip/Postal Code Residential Phone # Cell Phone # Email Address Policy Information Policy - First Name Policy - Last Name Storage Unit Number Self Storage Facility Name Self Storage Facility City Self Storage Facility State Self Storage Facility Phone Number Application/Certificate Number (Optional) Remarks Loss Information Date of Loss 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.
