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Name

Email Address

Phone Number

Best Form of Contact Best Form of ContactPhoneEmail

Best Time To Contact Best Time To Contact Early (9:00 AM - 11:45 PM) Afternoon (12:00 PM - 3:45 PM) Late (4:00 PM - 8:00 PM)

Cause of Loss Cause of Loss Wind Rain Hail All of the above

Related to a Storm Related to a Storm Yes No

Damaged Areas Damaged Areas Roof Siding Interior All of the above