Damage Assessment Report
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Incident Date
-
Month
-
Day
Year
Date
Type of Property
Single Family
Multi Family
Business
Vacation Home
Ownership
Rent
Own
Lease
Construction Type
Masonry
Wood Frame
Mobile Home
Manufactured
Other
Please specify construction type if you choose other option
Source of Damages
Sewer Backup
Primarily Flood
Wind / Wind driven rain
Tornado
Other
Please specify source of damages if you choose other option
Degree of Damage
Minor
Major
Destroyed
Where did the damage occur?
Describe the Damage
Upload a photo of the damage
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