Form Center

2. Storm Damage Intake - 2024
4. Name
5. Phone Number
7. Address1
9. City
10. State
11. Zip
13. Email
15. Damage Type

    1. Vegetative (trees, branches, etc.)
    2. Construction Demolition (wood, drywall, metal, roofing, etc.)
    3. White Goods (appliances)
    4. Hazardous Chemicals
17. Applied for FEMA Individual Assistance?
    -- Select One --YesNo
18. Do you have insurance?
    -- Select One --YesNo
19. Will your insurance cover this damage?
    -- Select One --YesNo
21. Are you physically unable to perform work needed?
    -- Select One --YesNo
22. Are you financially unable to hire the work done?
    -- Select One --YesNo
23. Do you have a way to transport debris to county’s debris site?
    -- Select One --YesNo
25. Do you need help with vegetative clearing? (such as trees or brush)
    -- Select One --YesNo
26. Do you need help transporting vegetative matter to the debris site?
    -- Select One --YesNo
28. Do you need help with construction demolition clearing? (such as wood, drywall, roofing, metal)
    -- Select One --YesNo
29. Do you need help with transporting construction demolition to the debris site?
    -- Select One --YesNo
31. Any additional information you would like to share
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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

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