Business Name
Degree of Damage
(Blank)
Affected
Minor
Major
Destroyed
Facility Owner or Renter
Street Address
City
ZIP Code
Business occupant
(Blank)
Owner
Leasee
Type of insurance
(Blank)
Structure and content
Contents (leasers)
Flood
Landslide
Earthquake
None
Business Continuity Insurance?
(Blank)
Yes
No
Date Damage Occurred
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
:
AM
PM
Description of damages
Contact Name
Contact Phone
Contact Email
Location
Street
City
State
Zip
City Kc Area
Zip Codes
2017 Census Tracts WA State