Business Flood Issues Form

2. BUSINESS FLOOD ISSUE FORM
   <center>Please fill out this form to report any issues from the flooding event on August 13, 2018</center>

   Please fill out this form to report any issues from the flooding event on August 13, 2018

4. First Name*

5. Last Name*

7. Phone Number*

8. Email Address*

10. Business Name*

12. Business Address*

13. City*

15. Cost of Inventory Lost*

17. Cost of Facilities Lost*

19. Cost of Economic Injuries*

21. List Other Issues Here*

23. Link To Pictures Or Video

    Please include any links to pictures or videos you have from August 13 or any issues from the flooding

25. Upload Picture Or Video

26. Upload Picture Or Video

28. Upload Picture Or Video

29. Upload Picture Or Video

31. Upload Picture Or Video

32. Upload Picture Or Video

Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field