Wylie Emergency Operations Center                Community Losses / Impact Reporting
Please complete this form so we can gain a better operating picture of the Winter Weather Disaster.  We just need an estimate at this time.

Only 1 response is needed.  There is no need to submit multiple responses.

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Email *
Household or Business Name   (ex: Smith Residence, etc.) *
Address of Home or Business (Number and Street, Suite)   (Ex: 1401 N. Ballard) *
City, State, Zip Code *
Primary Contact Name: *
Primary Contact Phone Number: *
Primary Email Address: *
Check all that Apply as of RIGHT NOW. (For instance, if the power is restored, then don't check Electricity is Intermittent.)
Property Ownership
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Is the Property Insured?
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Other Comments - Notes
I need immediate assistance from the Wylie Emergency Operations Center
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Property Type; *
For Businesses  or Other Properties:
Complete this section if you are a business
Name of Business or Other Property
Has your Business Ceased Operations?
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Best Option on Amount of Damage to Business
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Estimated Amount of Revenue Lost Due to Storm
How Many Employees Does the Business Employ
Is the Business Open or Closed?
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What Do you need to Open?  (Check all that Apply)
Submit
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