EmailMeForm
Damage Reporting
Hart County
Please understand this is not a guarantee of money/reimbursement. This is for damage assessment only.
Name
*
Email
Phone (Cell is preferred)
*
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Address/Location
*
Choose all that apply
*
Primary Residence
Commercial/Business
Agriculture
Choose One
*
Please select
Rent
Own
Do you have insurance
*
Please select
No
Yes
Describe Damage
Upload Pictures If Available (Front Side)
Upload Picture (Back Side)
Upload Picture (Right Side)
Upload Picture (Left Side)
