Individuals & Businesses Initial Damage Reporting

Individuals & Businesses Initial Damage Reporting

Please complete one survey per property address.

First Name

Last Name

Reporting Individual

Owner or Renter

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Property Street Address

City

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Zip Code

Contact Phone Number

Contact Email

Building Type

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Does the property have a basement?

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Primary Insurance Policy Type

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Is your house/property inaccessible?

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Damage Category

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What Caused the Damage?

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Description of Damages

Estimated Damage Amount

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