Customer Information - D & M Self-Storage


                

                        Basic Information

Name*
                            
                            
                                                    
                                                    First
                                                
                            
                            
                                                    
                                                    Last
                                                
                            
                        
Phone*
Address*    
                    
                         
                                        
                                        Street Address
                                    
                                    
                                    City
                                 
                                        
                                        State / Province / Region
                                      
                                    
                                    ZIP / Postal Code
                                
                    
                
Drivers License #* 



Employment Information

Employer* 
Address*    
                    
                         
                                        
                                        Street Address
                                    
                                    
                                    City
                                 
                                        
                                        State / Province / Region
                                      
                                    
                                    ZIP / Postal Code
                                
                    
                
Phone*



Unit Information

Which location are you looking at?
List all people that you want to have access to your unit.*       
Do you have insurance for your goods in storage?*
			
				
				Yes
			
			
				
				No
			
How long do you need to store your goods?* 
How did you hear of us?*
Have you ever used storage before?*
			
				
				Yes
			
			
				
				No
			
Are you aware that it is a violation of the law to store hazardous waste and certain chemicals in a storage unit?*
			
				
				Yes
			
			
				
				No
			
This unit will be used for which merchandise?*
Will you need a lock?*
			
				
				Yes
			
			
				
				No
			
What size storage unit will you need?* 
What is the state of registration and tag number of your vehicle?* 
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