First Name *

Last Name *

Phone *

Email *

Is your Maine home your primary residence *

Yes

I live there at least 6 months out of the year

Do you own or rent the property *

Own

Rent

Which county is the property located in? *

What type of property is this? *

Do you currently have an active homeowners insurance policy on this property? *

Yes

What best describes your roof’s current condition?

What type of roof does the home currently have?

Which household income range best applies to you? (Used only to assess potential eligibility for enhanced grants)

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

I understand that submission of this form does not guarantee eligibility or funding. The Maine Home Resilience Program provides educational outreach and eligibility screening only. Grant funding decisions are made by the Maine Bureau of Insurance and are subject to eligibility requirements and funding availability.