Malibu Chamber of Commerce Damage Survey
The purpose of this form is to create a database of the businesses that have been affected by natural disasters.
* Required
Email address
*
Your email
City of Malibu Boundaries
Damage to Business Verification
(check all that apply)
I verify that I have been affected by the (disaster) in the following way(s):
I reside in a mandatory evacuation zone
I suffered loss of income directly related to the disaster
I suffered substantial damage or complete loss to my place of business
I suffered physical injury directly caused by the disaster
Next
Never submit passwords through Google Forms.
This form was created inside of malibu.org.
Report Abuse
-
Terms of Service
Forms
