| Your Information |
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First Name*: |
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Last Name*: |
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Postal Code: |
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Phone*: |
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Email*: |
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Date of Birth [Y/M/D]: |
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Gender: |
Male
Female |
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Marital Status: |
Married
Single |
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| Property Information |
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Year Built: |
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Number of Stories (excluding basement) : |
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Basement? |
Yes
No |
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Distance to fire hydrant or firehall |
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| Exterior |
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Walls (Solid Brick, Brick veneer, wood, aluminum) |
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Update to Roof (ex. 2003) |
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Detached garage (1, 2 car or more ) |
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Swimming pool: |
Yes
No |
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| Interior |
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Flooring |
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Hardwood (%) |
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Ceramic (%) |
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Carpet (%) |
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Other* (%) |
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Kitchen (basic or custom) |
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| Utilities |
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Last plumbing update |
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Heating & Air Conditioning
Type of Heating (oil, gas, electric)
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Age of furnace |
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Age of oil tank and location (inside
or out) |
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Central air conditioning? |
Yes
No |
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