Commercial Client Intake

Point of Contact *

Is the Point of Contact the Owner, Tenant, or Other? *

Owner

Tenant

Other

Secondary Point of Contact

Is the Second Point of Contact the Owner, Tenant, or Other?

Owner

Tenant

Other

Company, Building, or Property Name (if applicable)

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Email (if applicable)

Phone Number *

Date of Disaster (if applicable)

Property Type *

Number of Units Affected (if applicable)

Insurance Claim Number (if applicable)

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Commercial Client Intake Form