The following items are blank or not valid and must be updated:
First Name
*
Last Name
*
Phone
*
e.g. 555-555-5555
Email
*
What type of property was damaged in the hail storm?
Residential Home
Trailer/Mobile Home
Condo
Commercial Property
Car/Vehicle
None of the Above
Was the property damaged insured?
*
Yes
No
What year was the property damaged in the hail storm?
*
-- Select --
2024
2023
Prior to 2023
WHERE IS THE PROPERTY THAT WAS DAMAGED?
City
State
-- Select --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
What is the estimated value of the damage to your property?
When would be a good time to call you?
--Select--
8am-10am
10am-12pm
12pm-2pm
2pm-4pm
4pm-6pm
Anytime
Central Time
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