CONTACT INFORMATION    * Indicates Required Fields

      Name:          *

      Address:      City:      State: 

      Phone:       *         E-Mail:        *  

      Best time of the day to contact you?        Morning  Afternoon  Evening

      HOUSE INFORMATION

      In what decade was your house built?
     Before 1950   1950s   1960s   1970s   1980s   1990 or later

      What type of siding do you have on the outside of your house? (Check all that apply.)
     Aluminum   Brick   Cedar   Stone   Stucco   Vinyl   Wood
     I'm Not Sure     

      What type of material do you have on your roof?
     Asphalt Shingles   Clay/Concrete   Cement Tile   Slate   Wood Shingles
     I'm Not Sure  

      What type of insulation do you have in your attic? (Check all that apply.)
     Blown-In Cellulose   Blown-In Fiberglass   Fiberglass Batts   Vermiculite
     I'm Not Sure
 
      What type of flooring do you have? (Check all that apply.)
     Carpet   Ceramic   Linoleum   Terrazzo  Wood   I'm Not Sure

      Do you have any textured ("popcorn-like") ceilings in your house?
     Yes   No   I'm Not Sure

      In what decade was your heating / air conditioning system installed?
     Before 1950   1950s   1960s   1970s   1980s   1990 or later

      Is there insulation on your boiler or heating pipes? (Check all that apply.)
     Boiler   Heating Pipes   Neither are insulated   I'm not sure

      Is there insulation on your furnace or duct work? (Check all that apply.)
     Furnace   Duct Work    Neither are insulated   I'm not sure  

      Do you have plans for a remodeling project or to sell your house?
     Yes, within the next 3 months.   Yes, in 3 - 6 months.   Yes, in 6 - 12 months.
     Not at this time.

      Comments / Details: