Damage Report For Businesses Only

Please complete the following information to report damage to your business. If you have questions, please call us at (360) 307-5870.

Name of business owner:
Name of property owner:
Business property address:
Mailing address:
Business phone number:
Home phone number:
Did the disaster economically impact your business? If you answer yes, please answer questions 7 through 14.
Yes
No
If yes, when did the impact start and end? Please list month and year started to month and year ended:
What were your business' revenues during that period?
What were your business' revenues during the same period of the prior year?
Amount of business interruption insurance received or anticipated, if any:
Provide a brief explanation of what adverse economic effects the disaster had on your business:
How many people did you employ PRIOR to the disaster?
How many people did you employ AFTER the disaster?
Did your business also suffer property damage? If you answer yes, please fill out questions 15 through 18.
Yes
No
If yes, estimated dollar loss to real property, (building), if owned:
Estimated dollar loss to contents, (machinery and equipment, furniture and fixtures, inventory, leasehold improvements, etc):
Insurance recovery received or anticipated for PROPERTY damages: