Disaster Recovery Registration & Asset Inventory Form

Marine Asset Inventory Form

Please list any assets your company has available that could aid in the recovery to your community in the case of a major disaster. This could be any type of community disaster (most common are hurricanes, flood & fire).
Program Participation is Voluntary

This is a voluntary program. Information submitted is to be utilized only in the event of a community disaster. Disclosing your company's information does not obligate you to provide any of the assets or services either voluntarily or for hire.
Business Name: *
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
GPS Location
Primary Contact *

First Name Last Name
Company Title
if applicable
Cell Phone Number *

Area Code Phone Number
Alternate Phone Number *

Area Code Phone Number
Email *
example@example.com
Secondary Contact *

First Name Last Name
Company Title
if applicable
Cell Phone Number *

Area Code Phone Number
Alternate Phone Number *

Area Code Phone Number
Please click region and counties served by your company. (To select multiple counties, hold the control button as you click on your choices)
Northwest Region (please click all counties that you serve)
Northeast Region (please click all counties that you serve)
Central West Region (please click all counties that you serve)
Central East Region (please click all counties that you serve)
Southwest Region (please click all counties that you serve)
Southeast Region (please click all counties that you serve)
Please check all items that your company would be willing to make available to your community emergency managers in the case of a disaster.
Air and Water Resources

Please give estimated quantity and description where applicable
Equipment

Please give estimated quantity and description where applicable
Supplies

Please give estimated quantity and description where applicable
Personnel

Please give estimated quantity and description where applicable
Misc. Items/ Other

Please feel free to add any other items that haven't made it on our list.
Should be Empty:

Marine Asset Inventory Form

Program Participation is Voluntary

Please click region and counties served by your company. (To select multiple counties, hold the control button as you click on your choices)

Please check all items that your company would be willing to make available to your community emergency managers in the case of a disaster.

Air and Water Resources

Equipment

Supplies

Personnel

Misc. Items/ Other