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Current Incidents:
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Business Reporting Form
Incident:
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Business Name:
Street Address:
City:
State:
Zip Code:
Contact Name:
Contact Phone:
Contact E-Mail:
Ownership:
Own
Rent
Is the property accessible?
Yes
No
Are You Insured?
Yes
No
Insurance Type:
Insurance Deductible:
Was the business closed due to storm?
Yes
No
If closed, how long?
Fair Market Value before storm?
(Building and contents)
Estimated property loss?
Estimated Business Furniture/ inventory Loss?
Describe your losses in detail:
chelandem.org
01/05/2009
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