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Data Collection Questionnaire

  1. Please answer the following questions regarding the house
  2. House Style
  3. Exterior Siding
  4. Roof Cover
  5. Central Air
  6. Interior Wall
  7. Interior Flooring

    Pick up to two

  8. Heating Fuel
  9. Type of Heat
  10. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

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  12. This field is not part of the form submission.