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1. Hurricane Matthew Damage Assessment

If you own your home and have damage caused by Hurricane Matthew, please complete this form. This form is for your primary residence only.

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your street address?

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* 4. Please List Phone and Email Address

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* 5. Do you rent or own the place where you live?

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* 6. Do you currently have an active homeowners insurance policy?

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* 7. Do you currently have Flood Insurance?

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* 8. List or describe type of damage done to your home. 

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* 9. What is the estimated cost of repairs not covered by your insurance company?

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* 10. How many people currently live in your household?

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