问 Is the mailing address same as the affected address?
答 Yes

问 Do you have a Basement, Crawl Space or Utility Room?
答 Basement

问 Is the Water backing up through the floor drain?
答 Yes

问 Is the Water clear or is there raw sewage?
答 Raw Sewage

问 Is your basement still flooded?
答 No

问 Are you Disabled or a Senior Citizen that Needs Assistance?
答 No

问 Do you have large items that require 2 or more people to move?
答 Yes

问 Do any of your neighbors on your side of the street have water back up also?
答 Yes

问 Date of damage?
答 2021年06月26日 12:00

问 Is the Customer on the HDTAP List (Check the HDTAP Eligible list provided)
答 Yes

问 Do you have a child under 10 in the house?
答 Yes

问 Do you need cleaning sanitation services?
答 Yes

问 Additional Information
答 We've lost our water heater, furnace, freezer, living room set, lots of clothes, 2 dressers, dining table set. I have more pictures but I can't upload but 1 picture on this app