Flight Attendant Disaster Relief
INQUIRY FORM
Date:
*
-
Month
-
Day
Year
Type of Disaster:
*
Name of Disaster, if applicable:
Ex. Hurricane Andrew, etc.
Your Full Name:
*
Employee Number:
*
Base:
*
Please Select
BOS
CLT
DCA
DFW
LAX
MIA
NYC
ORD
PHL
PHX
RDU
STL
Contact Information
Email
*
example@example.com
Best Telephone Contact Number:
*
Alternate Telephone Contact Number:
Residence Address:
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Residence County:
*
Insurance Information
Homeowner's Insurance?
*
Yes
No
If yes, what is the name of the Insurance Company?
Flood Insurance?
*
Yes
No
If yes, what is the name of the Insurance Company?
Insurance Deductible Amount:
*
Description of damage/losses to residence:
*
Please be as specific as possible.
Upload supporting document(s) here:
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Upload Photo(s)/Video(s) here:
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***All documents submitted and address provided with be verified.***
*
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*
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