Your full name:

Your email address: (e.g.: you@aol.com)

Home Phone:

Business Phone:

Property Street Adress:

City/Town:

Closing or Effective Date:

Mortgage Amount:

Purchase Price:

Frame or Brick? Frame Brick

# of Families:

Is property occupied by: Owner Tenant Vacant

Style:

Square Footage:

Year Built:

If over 20 years, please give years and details of upgrades:

Age of Plumbing:

Age of Roof:

Age of Heating System:

Age of Electrical System:

Type of Heat: Gas Oil Electric Other

Are there any underground fuel tanks? Oil Propane None

Garage: Attached Detached Built-In

# of Rooms:

# of Full Baths:

# of 1/2 Baths:

# of Stone Fireplaces:

# of Brick Fireplaces:

# of Wood Burning Stove:

Basement: Finished Unfinished

Basement Square Footage:

Deck/Porch Square Footage:

Deck/Porch: Open Closed

Smoke Detectors: Yes No

Fire or Burglar Alarm? Yes No

If Dog Owner, Breed:

Smoker? Yes No