First Name
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Last Name
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Phone
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Email
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Property Street Address
Property City
Property State
Bedroom Count
Bathroom Count
When is the last time you did renovations?
0-3 years ago
4-7 years ago
8+ years ago
Age of Roof
0-5 years
6-10 years
11-15 years
16-20 years
20+ years
Basement
Y
N
Attic
Y
N
Garage
Y
N
Property Condition (10=Best, 1=Worst)
1
2
3
4
5
6
7
8
9
10
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