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floodinfo@xactus.com
(844) 4EZ-CERT
Property Information
We need to get a few details from you about the property and this information will be placed onto your elevation certificate.
Name on Certificate
*
Title
--
Dr.
Miss
Mr.
Mrs.
Ms.
Prof.
Title
First or Business Name
First or Business Name
Middle name(s)
Middle name(s)
Last Name
Last Name
Generational
--
Jr.
Sr.
I
II
III
IV
V
VI
VII
VIII
IX
X
Generational
Property Address
This is the physical address of the property receiving the elevation certificate and the address where the surveyor will take measurements. Its also printed on the elevation certificate
Address 1
*
Address 2
City
*
State
*
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
--
Armed Forces (Americas)
Armed Forces (Europe, Canada, Middle East, Africa)
Armed Forces (Pacific)
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
Virgin Islands
ZIP code
*
Building Type
*
Single Family Home
Multi-family, Commercial, and Developer
Number of Buildings Requiring an Elevation Certificate
Contact Information
Preferred Method of Contact
- None -
Phone
Email
Phone
*
Please provide the best number to reach you for scheduling.
Confirm Phone
*
Email
*
Confirm Email
*
Insurance Agent Information
If you would like a copy of your elevation certificate sent to your flood insurance agent, please enter their contact information in this section.
Name
Company
Phone
Email
Accept Elevation Certificate Terms and Conditions
*
View the
Terms and Conditions
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