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1. Grower Entity Name
 (Required.)

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2. How many acres do you own (please indicate acreage by county)? (Required.)

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3. How many acres do you own (please indicate acreage by county)? (Required.)

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4. What is your estimated total fruit loss (as a percentage by county if possible)?

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5. What is your estimated total tree loss (as a percentage by county if possible)?

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6. What is the estimated acute wind damage to trees, if any?

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7. What is the total estimated acreage in standing water, (as a percentage by county if possible)?

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8. What, if any, structural damage did you experience? (eg. physical property including fences, equipment, greenhouses or other buildings)

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9. Please share any additional comments or specific needs for assistance that Florida Citrus Mutual may assist you with.

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