PLEASE COMPLETE THE FORM BELOW  * = field required
  ABOUT YOU    
  Name*  
  Address  
  (address cont'd)  
  City  
  State  
  ZIP  
  Phone*  
  Best Time to call:  
       
  ABOUT YOUR HOME    
  Style:  
  Year Built:  
  Square footage  
  Exterior:
 
  # of Bedrooms  
  # of Bathrooms  
  Laundry:  
  Basement:  
  Garage:  
  Garage (side entry): yes no  
  Heating System:  
  # of Fireplaces:  
  Fireplace locations:
Living Room Wood Gas
Great Room Wood Gas
Family Room Wood Gas
Master Bedroom Wood Gas
Basement Wood Gas
 
  Exterior:
Deck    
Patio    
Sprinkler    
Fenced    
Pool
Shed    
 
  Miscellaneous:
Security System    
Central Vacuum    
 
  Lot Size: x  
  How old is your:
Furnace
Roof
Air Conditioning
Windows
Carpeting
 
  Road:  
  Water:  
  Waste:  
  Hardwood Floors?:
Foyer    
Kitchen    
Nook    
Living Room    
Great Room    
Family Room    
Other
 
  Ceramic Floors?:
Foyer    
Kitchen    
Nook    
Other
 
  Time in Home: years  
  Specific features or other information you would like us to know about: