Natural Disaster Victim Inquiry If your property was damaged in a natural disaster, fill out the below form and we will be in touch with you right away. Please provide multiple contacts in the event we can’t get a hold of the main contact due to weather related issues. * required Contact information: Contact Person (#1): Full Name:* Phone:* Email:* Contact Person (#2 - optional): Full Name: Phone: Email: Contact Person (#3 - optional): Full Name: Phone: Email: About the property: Is the affected property Commercial or Residential?* CommercialResidential Address of property: Street Address (line 1):* Street Address (line 2): City:* State:* Zip Code:* Insurance Information: Do you have Insurance? YesNo If Yes: Insurance Company: Insurance Policy Number: Insurance Company Phone Number: Insurance Claim Number: Any additional information regarding your policy: Mortgage Information: Do you have a mortgage? YesNo If Yes: What bank is it with? : About the Damage Depth of the Flooding:* 0 - 12”12” - 24”24” - 48” Approx Square footage of the property damaged:* Upload pictures of the affected property (if you have more than 10 images, please let us know): Image 1: Image 1 Description: Image 2: Image 2 Description: Image 3: Image 3 Description: Image 4: Image 4 Description: Image 5: Image 5 Description: Image 6: Image 6 Description: Image 7: Image 7 Description: Image 8: Image 8 Description: Image 9: Image 9 Description: Image 10: Image 10 Description: How did you hear about us? Please leave this field empty.