First Name
Middle Initial
 Last Name
Address City State Zip Email Address
Year home or business constructed How many stories
Block or Frame Construction Gutters Yes or No Roof Shingles or Tile or Other




Number of exterior doors Number Of interior Doors
Number Of AC filters Sizes of AC filters
Number of Smoke Detectors Number of Sink Faucets
Number of Windows Exterior finish Stucco, Siding or Painted block


Air Conditioner Brand and
Model Number		 Approximate Age of Unit
Hot water Heater Electric or Gas Instant Hot Water Heater Yes or No
Trim size baseboards 3 1/4 or 5 1/4 Door casing 2 1/4 or 3 1/4
Soffits Aluminum or Painted wood Number of bathroom sinks
Color of electrical outlets and switches
Electrical outlets style Round or Rectangle Electrical switch style Single pole or rocker
Size of house or business

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