Damage Assessment Form
Shelby County
Information & Location
Event name
Please Select
March 3, 2023 Storm Event
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Name
First Name
Last Name
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Phone Number
Please enter a valid phone number.
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Email
example@example.com
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Type of Damaged Property
Please Select
Home
Vehicle
Utilities
Other Structure (Outbuilding, shed, etc.)
Other Property
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Any additional notes or information about the type & extent of damage.
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Is the damaged property covered by insurance?
Yes
No
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Deductible Amount
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Add any photos of the damage here
Browse Files
Drag and drop files here
Choose a file
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of
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Take Photo
Submit
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