Eaga Company LLC - Architectural Design Questionnaire

FIRE RESTORATION CONSULTATION QUESTIONAIRE

Fire Restoration Questionnaire

First Name*

Last Name*

Primary Email*

Primary Phone

What is your preferred method of communication*

Property Address*

Select a property type*

Provide insurance company name, agent name, and claim number, (if available)*

This is the date the fire occurred*

What is the status of the occupancy at the property*

State cause of fire

Select the affected areas*

Was there excessive smoke damage*

Was there structural damage

Was there excessive water dmage*

Will you require emergency services? (select all that apply)*

Have obtained contractor bids for the property*

Has any restoration work been started*

Has an insurance adjusted visited the property*

What level of restoration work will you require*

Select all that apply

Would like us to submit a bid for your selected level of restoration? It's included *

We will provide an estimate for restoration of your property - if we are awarded the contract your fee will be credited to the overall cost of the restoration

Upload any of the following documents - violations, photos, engineering reports, previous permits, floor plans*

Upload any of the following:

Fire Report, insurance quotes, violation notices, photos of affected area, engineering reports, previous permits, floor plans

Signature Block

Certification

Signature Block

Please sign, once you have confirmed your answers

Confidential Statement - EAGA Company, LLC

All information submitted is used solely for project evaluation and will remain confidential