Flood Loss Questionnaire

Flood Damage Survey and Assessment

It may be a few days or more before I can get out to inspect your property. But, rest assured, I will be there as soon as I can. In the meantime, please help me out by completing the following form. This will give me some additional information to complete your claim. Questions ending with an asterisk (*) need to be answered. When finished, hit the “submit” button.If you have any questions, please don’t hesitate to contact me.

Flood Loss Questionnaire
First
Last
Enter any special circumstances
Street Address
Street Address
First
Last
First
Enter month / day / year
Enter month / day / year
If no mortgage enter "None"
Enter date and time
Enter date and time
Amount in inches or "Don't know"
Amount in inches or "Don't know"
Name of Lake, Stream etc.
Miles or Feet
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