Winter Storm 2021 Damage

Please complete the Winter Storm 2021 Damage Form so we may see how we can serve you best..
Last Name of Primary Contact(*)
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First Name for Primary Contact(*)
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Best E-mail for Primary Contact(*)
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Best Phone Number for Primary Contact(*)
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Address of Damaged Home(*)
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Are you living at the address where the damage occurred? (if no, please add address where you are living)(*)
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Address of Where You are Living(*)
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Did you have home owners insurance?
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House Restoration:

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Please explain your house restoration plans
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Types of Volunteers Needed
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Personal Support

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Financial Resources include: FEMA money, personal resources, savings, loans, gifts, grants, SBA loan, etc.
Financial Resources

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Are there things that would be helpful for us to know?
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I would like someone to call me to discuss some of the ways I could use assistance.
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Anti-Spam
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