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Location
Emergency event:
Address:
Address is required
Zipcode:
Five digit Zipcode is required
Parcel Number:
Description
Is the property accessible?
Yes
No
Is the property livable?
Yes
No
What type of property is this report for?
-- SELECT A PROP. TYPE --
Residental
Commercial
Other
A report type is required
Do you own the property?
Own
Rent
Vacation Home (not a primary residence)
Add Images:
Upload Photos
Please enter the following information if this is your property:
Do you have homeowner's insurance?
Yes
No
Do you have flood insurance?
Yes
No
Do you have renter's insurance?
Yes
No
Damage
What is damaged?
Exterior Walls / Foundation
Roof
Windows / Entrance Doors
Siding
Electrical
Heating / Cooling
Water / Sewer
Type of Damage:
Flooding
Wind
Fallen Tree
Fire
Other
If there's flooding, the water height in the living area:
6" or less
6" to 12"
12" to 18"
More than 18"
Intervals are exclusive
If other, please describe the damage:
Additional notes:
Contact Information
Please provide the following information about yourself:
Your Name:
Your Phone Number:
Your Email:
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