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Fields marked (*) are mandatory.
Name*
Address*
Phone number*
Email*
Property Address (if different)
Type of Residence*
Are you the owner?*
Tenant?*
Number of stories*
Year built*
Square footage of home (total of all units)*
Number of Bathrooms (per unit)*
Garage *
How many number of car garage*
Chimneys (number)*
Brick*
Do the exterior walls have more than 10% brick or stone?*
If yes, what % is brick or stone