Environmental & Property Questionnaire

 

Ponderosa Insurance Agency, LLC 
Post Office Box 21747
Phoenix, AZ   85004
Fax: 602-745-6413

For a quick premium indication, please submit this form to us.

Facility
Name of Storage Facility
Address
City
State	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
ZIP Code
Contact
Contact Name
Daytime Phone
E-Mail
Replacement Cost Value
Building	$
Total Number of Buildings
Total Number of Self Storage Buildings
Total Square Footage All Buildings	Ft2
Number of Elevators	0 1 2 3 4 5 More
Year Built
Was building constructed for storage?	YesNo
Number of Storage Units
Number of Open Lot Storage Spaces (RV/Autos)