Damage Reporting | SRCPA

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Please fill out the required fields (marked with *) below.

Tell us how to get in touch with you:

Owner's Name:

*Email:

Phone:

Information about the damaged building:

*Street Address of Damaged Building:

*City:

*Zip Code:

Parcel ID:

Your Estimate of Damage

Building Uninhabitable / Condemned

Building Destroyed

Holes in Roof or Outside Walls - (Outside Damage)

Minor

Shingle Loss

Siding Loss

Shutters

Other (Explain Below)

Was there water in the home?

How Deep?

Damage Inside Home from Water / Wind

Collapsed Walls

Collapsed Ceiling

Stained Walls / Floors

Mold / Mildew

Electrical

All

Individual Outlets

Affected Areas

Rooms (Living Room, Master Bedroom, Kitchen, Etc.)

Other (Garage, Shed, Barn, Etc.)

Estimated Cost of Repair:

Estimated Date Repairs to be Completed:

Additional Comments