*1.Grower Entity Name
(Required.)

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

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

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

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

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

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

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

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