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About Home
Tell us about your home
Name
First Name
Last Name
Name
First Name
Last Name
Home Address:
Street Address
Address Line 2
City
State
Zip
Year Built
How many years have you lived here:
Heat:
Gas
Electric
Other
Number of bedrooms?
blanks
bathroom(s)
Air Conditioning
Gas
Electric
Other
Hot Water Heater
Conventional Tank
Tankless
Hybrid
Other
Septic?
yes
no
If yes, location?
Kitchen Appliances that will REMAIN
Refrigerator
Dishwasher
Ice Maker
Built in Oven
Built in Microwave
Stove
Cooktop
Other
If you checked other, list other appliances that remain
Roof Type?
Age?
Who Installed?
Warranty?
Fireplace: How many?
Gas or Wood burning?
Date of last cleaning?
Exterior Siding?
Aluminum
Vinyl
Wood
Date of install or last painted
Pool?
yes
no
Type:
Age
Serviced by
Fence
Wood
Metal
Chain link
None
Other
If "other", describe
Condition of the home?
Any recent updates to the home?
Any special features of the home?
POA/HOA mandatory fees:
Mo/Yr
Due Date
Contact
Number
Email
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