Location of property

Property Name:

Street Address:

City:

State/Province:

---AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming

Zip/Postal Code:

Directions to property:

Major Intersection:

Property details:

Year built?:

Last time of renovations?:

Multi-tenant building?:

SingleMulti-tenant

Description of building?:

Building square footage?:

Number of floors?:

Number of rooms?:

Floor covering type?:

Available blueprints and survey?:

YesNo

Back-up generator available?:

Any hazardous materials in the building? Yes or no:

YesNo

If yes, please describe exact locations and type of material:

Community gate access code?:

Preferred building access for service

Elevator access:

Special instructions:

Type of work pre-authorized:

Utility access, contacts and shut off locations:

Electric

Location of electrical panel?:

Key required?:

YesNo

If yes, where is located?

Provider Phone #?

Notes

Gas

Location of shut off valve?

Key required?:

YesNo

If yes, where is located?:

Provider Phone #?:

Notes:

Water

Location of shut off valve?:

Key required?:

YesNo

If yes, where is located?:

Provider Phone #:

Notes:

Alarm

Location of alarm panel?:

Key required?:

YesNo

If yes, where is located?:

Provider Phone #:

Notes:

Sprinkler

Location of shut off valve?:

Key required?:

YesNo

If yes, where is located?:

Provider Phone #?:

Notes ?:

Server/IT Equipment

Location ?:

Key required ?:

YesNo

If yes, where is located ?:

Provider Phone # ?:

Available IT personnel info?:

Notes:

Emergency Contact Info:

Your Name:

Phone Number:

Attachments

Choose a file from your computer to upload:

By checking this box you are giving your digital signature that you authorizing Global Enterprise Disaster Restoration to proceed in the future with Emergency Services.

I agree

Location of property

Street Address:

City:

State/Province:

---AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming

Zip/Postal Code:

Directions to property:

Major Intersection:

Property details:

Year built?:

Last time of renovations?:

Single or Multifamily building?:

SingleMulti Family

Description of building?:

Building square footage?:

Number of floors?:

Number of rooms?:

Floor covering type?:

Available blueprints and survey?:

YesNo

Any hazardous materials in the building? Yes or no:

YesNo

If yes, please describe exact locations and type of material:

Community gate access code?:

Preferred building access for service

Elevator access:

Special instructions:

Type of work pre-authorized:

Utility access, contacts and shut off locations:

Electric

Location of electrical panel?:

Key required?:

YesNo

If yes, where is located?

Provider Phone #?

Notes

Gas

Location of shut off valve?

Key required?:

YesNo

If yes, where is located?:

Provider Phone #?:

Notes:

Water

Location of shut off valve?:

Key required?:

YesNo

If yes, where is located?:

Provider Phone #:

Notes:

Alarm

Location of alarm panel?:

Key required?:

YesNo

If yes, where is located?:

IProvider Phone #:

Notes:

Sprinkler

Location of shut off valve?:

Key required?:

YesNo

If yes, where is located?:

Provider Phone #?:

Notes ?:

Emergency Contact Info:

Your Name:

Phone Number:

Attachments

Choose a file from your computer to upload:

By checking this box you are giving your digital signature that you authorizing Global Enterprise Disaster Restoration to proceed in the future with Emergency Services.

I agree

Your Name:

Your Email(required)

What is the best phone number to reach you?

Fax Number:

Property Address::

City:

State/Province:

---AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming

Zip/Postal Code:

Type of property damage?:

FireSmokeWaterStormMoldOther

If “flood”, do you need emergency water extraction?:

YesNo

When did the damage occur?:

Do you own the property?:

YesNo

Is this commercial or residential property?:

CommercialResidential

Do you live at the property?:

YesNo

Is the property insured?

YesNo

Have you filed a claim for this damage:

YesNo

Your Message:

By checking this box you are giving your digital signature that you authorizing Global Enterprise Disaster Restoration to proceed in the future with Emergency Services.

I agree