We’re sorry about your property loss. Please fill out the form below and press the “Submit” button at the bottom of the page when finished. Upon confirmation of coverage, a claim representative will contact you and assist you through the claim process.

Insured/Certificate Holder
Today's Date*
Date Format: MM slash DD slash YYYY
First Name*
Last Name*
Company Name (if applicable)
Address*
Street Address City State ZIP Code
Primary Phone*
Other Phone
Email Address
Insurance Coverage
Certificate Number
Unit Number*
Lease Origination Date
Date Format: MM slash DD slash YYYY
Insurance Policy Date
Date Format: MM slash DD slash YYYY
Coverage Amount
Deductible
Other Insurance on Property
Storage Facility Information
Facility Name*
Address*
City*
State*
Zip*
Manager's Name
Phone
Loss
Date of Loss*
Date Format: MM slash DD slash YYYY
Cause of Loss*
Description of Cause of Loss*
Date Damage Discovered*
Date Format: MM slash DD slash YYYY
Discovered By
Description of Damage*
Police/Fire Report Filed*
- Yes
- No
Date Reported
Date Format: MM slash DD slash YYYY
Department
Report Number
If you would like to submit photos with your loss notice, please email them to claiminfo@baderco.com. If you would prefer to submit the loss notice via fax, please print the form and fax it to 314-821-7625.

Insured/Certificate Holder