Storage Unit Request
Storage Unit Request
*Clear Home's corporate form of payment is American Express. Be aware that you will need to find a storage unit that accepts this form of payment
Agemni Area Name:
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Lead Tech Name
Lead Tech Name
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First
Last
Lead Tech Contact #
Lead Tech Contact #
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# of units requested
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1
2
3
Size of Storage Unit Needed
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Date Storage is Needed
Date Storage is Needed
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/
MM
/
DD
YYYY
Name of Property
*
Property Contact #
Property Contact #
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Address
Address
Street Address
Address Line 2
City
State / Province / Region
Select a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal / Zip Code
Country
United States
Does this storage unit have freight truck access?
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Yes
No
Does this storage unit have a dumpster we can use?
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Yes
No
Will they allow us to put a dumpster on site?
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Yes
No
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I understand that I am responsible for all trash if storage can't accommodate a dumpster
Does this storage unit have 24 hour access?
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Yes
No
Will this storage unit accept shipments on our behalf?
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Yes
No
Notes: