Q. Is the mailing address same as the affected address?
A. Yes

Q. Do you have a Basement, Crawl Space or Utility Room?
A. Basement

Q. Is the Water backing up through the floor drain?
A. Yes

Q. Is the Water clear or is there raw sewage?
A. Dark Water

Q. Is your basement still flooded?
A. Yes

Q. Are you Disabled or a Senior Citizen that Needs Assistance?
A. Yes

Q. Do you have large items that require 2 or more people to move?
A. Yes

Q. Do any of your neighbors on your side of the street have water back up also?
A. Yes

Q. Date of damage?
A. 26 يونيو 2021 12:00

Q. Is the Customer on the HDTAP List (Check the HDTAP Eligible list provided)
A. No

Q. Do you have a child under 10 in the house?
A. No

Q. Do you need cleaning sanitation services?
A. No

Q. Additional Information
A. Resident requesting assistance with cleanup and has multiple large utilities that need to be removed from basement. Also requesting claim form to be mailed