This form needs to be completed to process all claims.

First Name*

Last Name*

Business Name

Unit Number*

Floor Location*

Telephone Number*

Tenant Insurance* (Provide us valid certificate of insurance) dated start of Lease!

Email Address*

Have you pick up your items from the Building*
-select an option-YesNo

Have you been in contact with the Building Yet?*
-select an option-YesNo

What actions do you want to take on existing contract?*
-select an option-New OfficeCancel Contract

Please Provide us with as much details as possible*