How would you like me to contact you: Home Phone Business Phone Fax Email Name: Address: City: Province: Postal Code: E-Mail: Phone #: Please describe what type of home you presently own: Type of Residence: Bungalow Two Storey Three Storey Split Level Semi Bungalow Hi-Ranch Link Semi Detached Bungalow Semi Detached Split Semi Detached Two Storey Row Unit Apartment Court Home Garden Home Townhouse # of Bedrooms: One Two Three Four Five plus Garage: One Two Three Four or More Ensuite: Yes No # of Bathrooms: One Two Three Four or More Family Room: Basement Mid-level Main Floor Basement: Unfinished Partly Finished Fully Finished Laundry: Basement Mid-level Main Floor Second Floor Flooring: Wall-to-wall Hardwood Softwood Fuel: Electric Natural Gas Oil Furnace: Baseboard Forced Air Heat Pump Air: Central air Heat pump Window Unit None Please include any special features you might want with the house. (i.e. alarm system, pool, fireplace, etc.)

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