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1. Default Section

* 1. Please provide the following contact information:

2. Has your residence or business sustained STRUCTURAL damage due to flooding or wind damage from Irene?

3. Is damage visible from the outside of the structure?
This will help damage assessment teams determine if appointments will need to be scheduled with property owners

4. Is this property a:

5. Brielfly describe the structural damage to your residence or business

6. If you're reporting other property damage, such as fallen trees and limbs, or cars that were damaged due to flood waters or trees, please describe the damage below.

7. Is this property occupied by:

8. Is this propery accessible for inspection at a later date?

9. Are you still able to live in the home or stay open for business?

10. What type of insurance do you have for this property?

11. Have you contacted your insurance company and also documented the damage for your own records (ie photos, video)?

12. For business owners: did you have to close your business as a result of the storm, if yes, please briefly describe impact on your operations (ie # of days closed, income lost, etc)

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