Rockton Chemtool Fire Questionnaire – Business

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Has your business been affected by the Chemtool fire? If so, how?(Required)

Were you required to leave your business, or was your business required to close due to the fire? If so, for how long?(Required)

Is your business still being interrupted/closed?(Required)

UntitledWas the structure of your business affected by the fire? If so, how was it affected?(Required)

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