Real Estate Flood Disclosure Form

Property Owner/Agent Full Name

First NameLast Name

Contact Email Address

example@example.com

Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Property Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Property Type

Is the property located within a designated flood zone?

Has the property ever experienced flooding?

If yes, please specify the years and describe the extent of flooding.

Has the property had any flood-related insurance claims?

Please indicate which of the following flood-related issues have occurred at the property (select all that apply):

Have any flood mitigation measures been implemented? (e.g., sump pump, grading, barriers)

If yes, please describe the flood mitigation measures taken.

Additional Comments or Disclosures (optional)

Signature of Owner/Agent