This form is for Initial Damage Reporting only.
If there is an emergency, please dial 911.
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Location
Emergency event:
This report is for:
-- SELECT A REPORT TYPE --
Debris Clearance
Residential Damage
Commercial/Industrial Damage
Public Facility Damage
Damage Report Type is required
Address:
Address is required
Zipcode:
Five digit Zipcode is required
Description
Please describe the damage:
Add Images:
Upload Photos
Please enter the following information if this is your property:
Are you reporting damage to your primary residence or a secondary residence?
Primary
Secondary
Do you have homeowner's insurance?
Yes
No
Don't Know
Is the property your reporting damage for covered by flood insurance?
Yes
No
Don't Know
Have you been told by insurance company or adjustor you have damage that is not covered by insurance?
Yes
No
Is this a business?
Yes
No
Don't Know
If yes, enter the business name:
Contact Information
Please provide the following information about yourself:
Your First Name:
Your Last Name:
Your Phone Number:
Your Email:
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