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)