Request and Contact Information
I am submitting this request as
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Adjuster / claims professional Insurance carrier or TPA Policyholder / resident Restoration or construction contractor Employer / project coordinator Government or emergency response Other
Requester Email
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Requester Phone
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Company, Organization, or Insurance Carrier
Type of Temporary Housing Request
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Insurance claim / ALE Disaster recovery Restoration or construction workforce Corporate assignment Event or production Other
Claim Number (if applicable)
Insurance Carrier (if applicable)
Adjuster or Claim Contact Email
Adjuster or Claim Contact Phone
Requested Placement Address, City, State, and ZIP
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Desired Move-In Date
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How soon is housing needed?
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Needed today / tonight Within 2–3 days Within one week Planning ahead Not sure
Number of Adults
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Number of Children
Pets — Type and Number
Accessibility or Mobility Needs
Sleeping Arrangements, Bedroom Needs, or RV Size Notes
Preferred RV Type or Size
No preference / best fit Travel trailer Fifth wheel Driveable motorhome Not sure
Where will the RV most likely be placed?
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At the damaged residence or property Nearby private property Campground or RV park Worksite or event site Not sure
Do you have property-owner authorization for RV placement?
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Yes No Not sure / authorization pending
Are there permit, HOA, CC&R, or local placement restrictions?
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No known restrictions Restrictions or permits may apply Permit or HOA approval is in progress Not sure
Primary Site Surface
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Paved Gravel Grass Dirt Mixed / other Not sure
Can an RV and delivery vehicle safely access the site?
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Yes Possibly — site review needed No Not sure
Site Access Details — Gates, Slopes, Turning Room, Surface, and Overhead Clearance
Electrical Hookup Available
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50-amp RV hookup 30-amp RV hookup Standard 15/20-amp outlet only Generator needed No power available Not sure
Potable Water Available
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Potable hose bib Well connection Water delivery or tank needed No water available Not sure
Wastewater Disposal Available
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Sewer hookup Approved septic hookup Pump-out service needed No wastewater connection Not sure
Estimated Placement Duration
Additional Details or Special Requests