Report Property Damage

Your Name (required)

Your Email (required)

What is the best phone number to reach you?

Fax Number:

Property Address:

City:

State/Province:

Zip/Postal Code:

Type of property damage?
 Fire Smoke Water Storm Mold Other

If “flood”, do you need emergency water extraction?
 Yes No

When did the damage occur?

Do you own the property?

 Yes No

Is this commercial or residential property?

 Commercial Residential

Do you live at the property?

 Yes No

Is the property insured?

 Yes No

Have you filed a claim for this damage?

 Yes No

Your Message

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

 I agree