Storm Damage Report

2. Please let us know if your home has suffered storm damage
   This report is designed to assist the Seabrook Office of Emergency Management in determining what areas have experienced storm damage so assessment teams can evaluate those locations. <br><br>Please DO NOT use this form to request direct assistance or disaster relief. As always, call 911 for emergency assistance.

   This report is designed to assist the Seabrook Office of Emergency Management in determining what areas have experienced storm damage so assessment teams can evaluate those locations.
   
   Please DO NOT use this form to request direct assistance or disaster relief. As always, call 911 for emergency assistance.

4. First Name*

5. Last Name*

7. Phone Number*

8. Email Address*

10. Physical Address that Incurred Damage*

12. Date Damage Occured*
    Date Damage Occured

13. Subdivision

15. Address1

17. City

18. State

19. Zip

21. Did you have water in your home?*

    1. Yes
    2. No

22. If your home flooded, what caused your flooding? (check all the apply)*

    1. Storm Surge
    2. Rain

24. How high was the water in your home? (ex. 3 inches, 1 foot)*

25. Did your home suffer wind damage?*

    1. Yes
    2. No

27. Describe your home's damage*

29. Do you have home insurance?*
    -- Select One --YesNo

30. Do you have flood insurance?*
    -- Select One --YesNo

32. Do you own or rent your home?
    -- Select One --OwnRent

33. If you have any photos of your damage please upload them here

Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field