Small Business Administration Questionnaire
Home Address:
Your answer
Do you rent or own your home?
Rent
Own
If you own your property, is it currently leased or rented?
Yes
No
Does your renter have contents insurance?
Yes
No
Which type of insurance do you have?
Property
Renters
Contents
I do not have rental, property or contents insurance
Does the total cost of repairs exceed insurance coverage?
Yes
No
I do not know the total cost of repairs at this time.
If you answered yes to the previous question, what was the total cost of damage? Please provide property and content values separately. (Leave blank if you do not know the cost of damage)
Your answer
What was the cost covered by your insurance? Please provide property and content values separately. (Leave blank if you do not know the cost of damage)
Your answer
Has your home structure shifted from its foundation?
Yes
No
Unsure
If you are willing to let the Small Business Administration contact you for follow-up questions, please list your preferred contact method:
Your answer
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