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About
Our Company
Our Promise
Our Team
Testimonials
Projects
Services
Client Intake
Commercial Client Intake
Residential Client Intake
Contact
Contact Us
Work For Us
Residential Client Intake
chip evans
2021-07-30T16:40:09-04:00
Residential Client Intake Form
Residential Property Client Intake Form
Tell us about You, the Property & the Disaster.
TELL US ABOUT YOU
First Name
*
Last Name
*
Email (if applicable)
Preferred Phone Number
*
Adress Line 1
*
Address Line 2
City
*
State
*
Zip Code
*
TELL US ABOUT THE PROPERTY
Type of Residence
*
Single Story
Two Story
Split Level
Townhome
Is the property occupied?
*
Yes
No
Is this a rental property?
*
Yes it is a rental
No it is my residence
If a rental property, are you the:
Owner
Tenant
Other
Secondary Contact (if applicable)
If a rental property, what is the tenant's name?
Is this an insurance claim?
*
Yes
No
Undecided
If yes, insurance company?
Insurance Agent (if applicable)
Claim Number (if applicable)
TELL US ABOUT THE DISASTER/DAMAGE
Date of Disaster (if applicable)
Services Needed (check any that may apply)
Water Damage
Fires/Smoke Damage
Content Cleaning
Mold Remediation
Storm Damage
Biohazard Clean Up
Crime Scene/Trauma Clean Up
General Restoration or Remodel
Tarping/Boarding
Other
Brief Description of Disaster/Damage or What Services You May Need:
*
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