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2. Name*
3. Email Address
5. Property Address*
7. City*
8. State
9. Zip Code
11. Phone Number*
13. Parcel ID# (can be found on orange card left at door)
17. Year Built of Home (estimate)*
18. Year Built of Additions (can list multiple years, if any. If non, enter N/A.)*
20. # of Bedrooms (above grade - ground level and above)*
    -- Select One --012345678910 or More
21. # of Bedrooms (below ground, lower level of a split level)*
    -- Select One --012345678910 or More
23. # of Bathrooms (Full Bath)*
    -- Select One --012345 or More
24. # of Bathrooms (3/4, shower stall only)*
    -- Select One --012345 or More
25. # of Bathrooms (1/2 Bath)*
    -- Select One --012345 or More
27. Percentage of Livable Space in Basement*
    -- Select One --0%10%20%30%40%50%60%70%80%90%100%
28. Main Floor Laundry?*
    -- Select One --YesNo
30. Percentage of Livable Space in Attic*
    -- Select One --0%10%20%30%40%50%60%70%80%90%100%
31. 
33. Year of Siding (Estimate)*
34. Year of Windows (Estimate - can list multiple years)*
35. Year of Roof (Estimate)*
37. Year of Kitchen Cabinetry/Countertops (if applicable)*
38. Year of Bathroom Updates (Estimate - if applicable)*
39. Year of Furnace (Estimate - if applicable)*
41. Does House have In-Floor Heat?*

    1. Yes
    2. No
    3. I don't know
42. Does House have Geo-Thermal System?*

    1. Yes
    2. No
    3. I don't know
43. Any Heat Source in Garage?*

    1. Yes
    2. No
    3. I don't know
45. I certify that the information provided is true and correct to the best of my knowledge.*

    1. Yes
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47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

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