Business Flood Issues Form

2. BUSINESS FLOOD ISSUE FORM
   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