Account Manager Request Form Add or Delete a Property
Client Name / Name of Person Requesting the Change
*
First Name
Last Name
Account Manager Submitting Form
*
Please Select
Shirley Monson
Kathy Busse
Joy McFarlane
Gabby Ruder
Melissa Rodriguez
Effective Date of Change
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are they Adding or Deleting a Property
*
Adding a Property
Deleting a Property
Titled Name of the Property
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this property a new purchase?
*
Yes
No
Purchase Price
Closing Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Occupancy/Use
*
Please Select
Primary
Secondary
Seasonal
Vacant
Tenant
Short-term Rental
Is there a mortgage?
*
Yes
No
Mortgage Info
Year Built
*
Home Style/Type
*
Please Select
1 Story
1.5 Story
2 Story
2.5 Story
Bi-level Split
Tri-Level Split
Age of Roof
*
Year of Heating System
*
Year of Electric System
*
Year of Plumbing System
*
Total Finished Square Footage
*
Square Footage of Footprint/Foundation
*
Does the property have a Basement?
*
Yes - Standard Basement
Yes - Walkout Basement
No
Sump Pump?
*
Yes
No
Is there a Back-up Sump Pump
*
Yes - Gas
Yes - Battery
No
Does the property have any auxiliary heating units? (Select all that apply)
*
Gas Fireplace
Wood Fireplace
Wood Burning Stove
None
Pool?
*
Please Select
Yes
No
Trampoline?
*
Please Select
Yes
No
Pets?
*
Yes
No
Describe Pets
Alarm
*
Please Select
Local Alarm
Central Monitoring Alarm
No Alarm
City Water?
*
Please Select
Yes
No
Any scheduled maintenance, repairs, or rennovations?
*
Submit
Should be Empty: