TenantOne Direct Insurance Application

TENANTONE DIRECT INSURANCE APPLICATION

Questions about this application? Call 800-544-6464 for more information.

Your personal information is strictly confidential and will be retained for our use only.

CUSTOMER INFORMATION

Policy Effective Date _____________________________________ Name ___________________________________________________________________________________________ Address _____________________________________________________________ Apt. No. ___________________ City __________________________________________________ State ___________ ZIP ___________________ Daytime Phone __________________________________ Evening Phone __________________________________ Mobile Phone ___________________________________ Alternate Phone __________________________________ E-mail Address ___________________________________________________________________________________

FACILITY INFORMATION

Facility Name __________________________________________ Facility # (see back of brochure) _______________ Facility Address ___________________________________________________________________________________ City __________________________________________________ State ___________ ZIP ___________________ Facility Phone __________________________________________

Coverage Limits

and Premiums

TenantOne Limits

Monthly Premium

$ 1,000

$ 5

2,000

8

3,000

12

5,000

20

10,000

38

15,000

54

20,000

71

25,000

87

Limits are available up to $75,000.

Refer to the drop-down items in the form below to review all available limits and premiums.

Contact MiniCo at 800-5446464 for more information.

Unit Number

Amount Of Coverage

____________ $ ____________

____________ $ ____________

____________ $ ____________ Type of goods in storage:

Household and personal property Commercial or business property

Total Number of Months

____________ ____________ ____________

Monthly

TOTAL

Premium

PREMIUM

x $ ____________ = $ ____________

x $ ____________ = $ ____________

x $ ____________ = $ ____________

GRAND TOTAL $ ____________

Each unit must be separately insured.

Up to three units are allowed per policy.

All units on the policy must be insured for the same number of months.

Payment: Print this application and submit with payment to MiniCo Insurance Agency. Mail to 10851 N. Black Canyon Highway, Suite 200, Phoenix, AZ 85021 OR fax to 800-637-4981 OR scan and e-mail to tenantone@.

I Agree ? Yes No (Required) I Agree ? Yes No (Required)

Any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and subjects the person to criminal and civil penalties.

The company reserves the right to request an inventory and appraisal of your items in storage. In the event of a loss, the insured is responsible for producing an accurate record of damaged and undamaged articles and proof of ownership. I further understand and agree that the issuance of coverage is based on this application.

SIGN APPLICATION _________________________________________________________ DATE ______________________________________

The following goods are uninsurable and automatically excluded from coverage: accounts, deeds, bills, currency, evidence of debt, securities, money, notes, jewelry, watches, precious stones, furs or garments trimmed with fur, and boats or vehicles stored in the open. Other restrictions may apply to items in storage.

This form contains general and descriptive information; the policy is the contract. Tenant insurance may duplicate coverage already provided by your personal homeowner's insurance policy, automobile insurance policy, personal liability insurance policy or other source of coverage.

IMPORTANT INFORMATION ? PLEASE READ CAREFULLY

The earliest coverage can begin is 12:01 a.m. the day after this application and payment is received by MiniCo Insurance Agency. Coverage on

applications made while the storage facility is under a hurricane watch or warning will not become effective until 12:01 a.m. on the day after the

hurricane watch or warning is lifted.

All applications are subject to approval.

Coverage is valid at the named storage facility location only.

TenantOne Direct is underwritten by Safeco Insurance Company of America and Aspen American Insurance Company. Both are A.M. Best "A" rated

carriers. Your policy will be issued by one of these companies at the discretion of the MiniCo underwriter.

CA License 0H04984. Copyright ? MiniCo Insurance Agency, LLC.

T1D ADD WEB

Rev. 12/2018

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