* 1. First Name

* 2. Last name

* 3. Primary phone number

* 4. Alternate phone number

* 5. Address of flooded / damaged location

* 6. Date facility was damaged

* 7. About how much water in your facility

* 9. Do you have flood insurance

* 10. Was any part of your property damaged in the Tax Day Floods of 2016?

* 11. If the answer to #10, was "yes", did you sustain any damage in the Memorial Day Weekend Floods of 2016 that was different than the damage from the Tax Day Floods?

* 12. If your answer to #11 is yes, please describe how the damage was different:

T