REFERRED BY:________________________ PHONE:________________________

NAME:_______________________________________________________________

PHONE:___________________________H/W________________________________

ADDRESS:________________________CITY:_________________ZIP:__________

YR HOUSE BUILT:_______1 OR 2 STORIES SQ FT PER FLOOR:_______________

GARAGE: ATTACHED?_______ BUILT IN?________DETACHED?________________

GARAGE DOOR OPENER:_______ EXTERIOR COVERING:______________________

ROOF TYPE:_________________________ AGE OF ROOF:____________________

PORCH:________________ OPEN OR CLOSED # OF DECKS:_________________

# OF BATHS:___________ # ½ BATHS:__________ SHOWER STALLS:__________

# OF FIREPLACES:____________ HARDWOOD FLOOR:_______________________

TRASH COMPACTER:_______ SAUNA/HOTTUB:_______ POOL:_________________

WET BAR:_________ MARBLE COVERINGS:_______ SELLING PRICE:____________

DO THEY WANT EARTHQUAKE?_________ OR FLOOD INSURANCE?______________

SSN'S:______________________________________________________________

DOB'S:______________________________________________________________

OCCUPATIONS:_______________________________________________________