RELIEF GANG DISASTER ASSISTANCE
In order to be considered for our disaster assistance please complete form to the best of your ability. We will reach out if and when we can dispatch a plumber to help with repairs. We will not disclose, share or sell your information. Please provide full address with zip code and apartment number if applicable. We are only currently providing assistance with plumbing repairs.
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NAME *
DATE OF BIRTH *
MM
/
DD
/
YYYY
DO YOU HAVE A PLUMBING ISSUE THAT NEEDS TO BE FIXED? *
ADDRESS (STREET, CITY, ZIP) *APT # *
PHONE NUMBER *
EMAIL
HOUSEHOLD *
HEAD OF HOUSEHOLD?
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WHAT IS YOUR HOUSING TYPE? *
DO YOU HAVE HOMEOWNERS INSURANCE? *
WHAT SECTION OF YOUR HOME SUSTAINED DAMAGE? PLEASE DESCRIBE, IF POSSIBLE. *
I UNDERSTAND THAT THIS APPLICATION DOES NOT GUARANTEE DISASTER ASSISTANCE. WE WILL APPROVE APPLICATIONS AND DISPATCH PLUMBERS BASED ON AVAILABILITY AND NEEDS. *
Required
I UNDERSTAND THAT RELIEF GANG IS SUBCONTRACTING PLUMBERS. RELIEF GANG IS NOT LIABLE FOR ANY DAMAGE SUSTAINED TO HOMES. OUR EMERGENCY ASSISTANCE DOES NOT GUARANTEE THAT WORK CAN OR WILL BE COMPLETED. *
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