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FIRST AND LAST NAME
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Your answer
PHONE NUMBER
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Your answer
EMAIL
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Your answer
ADDRESS OF PROPERTY (STEET/CITY/ZIP)
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Your answer
DO YOU ATTEND CROSS CHURCH? (NOT REQUIRED TO RECEIVE HELP)
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Yes
No
ARE YOU ON THE CROSS CHURCH SERVE TEAM? (NOT REQUIRED TO RECEIVE HELP)
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Yes
No
ARE YOU ELDERLY, DISABLED, OR HAVE PHYSICAL LIMITATIONS?
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YES
No
INSURANCE STATUS
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INSURED
UNINSURED
UNDERINSURED
IF YOU ARE NEEDING TREE REMOVAL, PLEASE EXPLAIN WHAT NEED TO BE CUT/REMOVED AND IF IT CAN BE ACCESSED.
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WHAT IS THE MOST IMMEDIATE NEED?
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Your answer
PLEASE EXPLAIN ANYTHING ELSE THAT WOULD HELP US UNDERSTAND YOUR SITUATION.
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