* First Name:

* Last Name:

* Primary contact number:

* Email:

Best time to contact you:

Address:

Type of home:

Age of property:

Number of bedrooms:

Number of bathrooms:

Ensuite bath:

Garage type:

---SingleDoubleAttachedDetachedNone

Heating:

Fireplace:

Main floor family room:

Air conditioning:

Finished basement:

Kitchen:

Main bathroom:

Ensuite bathroom:

Powder room:

Family room:

Windows:

Flooring:

Basement:

Shingles:

Wiring:

Additions:

Other:

Additional comments: