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Complete one form for each building.

We recommend that you print this information before you send it to us.

Contact Information:

Name:

Title:

Telephone Nr:

Fax Nr.

E-mail address:

Building Location:

Building Id:

If one does not exist, assign a unique one. 

Location Id:

If one does not exist, assign a unique one.

 

Prioritize the areas that most important  to the operation of your building in the event of a major loss:

1.

2.

3.

4.

5.

Do you have a plan to set up a management crisis area or center in the event of a major loss?   Yes  No

Notes: