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* 1. Grower Entity Name

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* 2. How many acres do you own (please indicate acreage by county)?

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* 3. How many acres do you own (please indicate acreage by county)?

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* 4. What is your estimated total fruit loss (as a percentage by county if possible)?

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* 5. What is your estimated total tree loss (as a percentage by county if possible)?

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* 6. What is the estimated acute wind damage to trees, if any?

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* 7. What is the total estimated acreage in standing water, (as a percentage by county if possible)?

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* 8. What, if any, structural damage did you experience? (eg. physical property including fences, equipment, greenhouses or other buildings)

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* 9. Please share any additional comments or specific needs for assistance that Florida Citrus Mutual may assist you with.

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