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  1. Surveys
  2. 2015
  3. January
  4. C
  5. Customer Flood Tracking
0%
Exit Survey »
 
 
Are you the owner of the home?
 
Yes
 
No
 
Owners Name & Phone #
 
 
 
Please Enter Owner Information
First Name : 
Last Name : 
Address 1 : 
Address 2 : 
City : 
State : 
Zip : 
Phone : 
Email Address : 
 
 
 
Is this a commercial or Residential property?
 
Commercial
 
Residential
 
Vacant
 
 
 
Do you know what caused the flood?
   
 
 
 
How long has it been leaking/flooding?
 
Unsure- Don't Know
 
<30 min.
 
1-5 Hrs.
 
5 Hrs. +
 
1-2 Days
 
2 Days +
 
1-2 Weeks
 
1-2 Weeks +
 
See Notes
 

 
 
 
How much Water/Sewer has entered the home?
 
<1-2"
 
2-6"
 
6-12"
 
>1ft.
 
See Notes
 
 
How many Sq Ft. are affected?
N/A <50 ft. 50-100 ft. 100-200 ft. 200-500 ft. 500- 1000ft. 1000ft. +
Ceiling
Drywall
Paneling
Baseboard
Carpet
Tile
Hardwood
Laminate
Cement
Crawl Space
Other (See Notes)
 
 
 
Have you filed a claim with your insurance company?
 
Yes
 
No
 
Claim Number
 
 
 
Insurance info (if applicable)
Agent : 
Adjuster : 
Phone : 
Email Address : 
 
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