E-Mail Address:    
Property Address:     :
City, State, Zip: 

Year Built:  

Square Footage
Floor 5:            
Floor 4:            
Floor 3:           
Floor 2:           
Floor 1:           
                                            Basement:                       % Basement Finished 
TOTAL:          

# Bedrooms:  1 2 3 4 5 6 7 8 9 10+

# Bathrooms
# Full Baths:                                             
# Three Quarter Baths:                             
# Half Baths:                                             

Home Style:   Select One 2-Story Bi-Level/Split-Entry Bungalow Cottage Rambler Ranch Tri-Multi Level Other-Explain In Add-Features

Parking:  Select One Carport 1-Car Carport 2-Car Garage 1-Car Garage 2-Car Garage 3-Car Other - Explain in Add-Features

Additional Featureds and Upgrades:

Overall Condition:  Select One Poor Fair Average Good Excellent

If For Tax Adjustment:       New Value: 

Is this for tas assessment?    Yes      No

Are You Planning to Sell Your Home?    Yes      No

Will You Buy Another Home?    Yes       No

Do You Want To Refinance?    Yes   

The information below is optional
unless you are requesting comparables for a tax adjustment
in which case the information is required.

First Name: 
Last Name: 
Address: 
City:    State:    Zip Code: 
Phone: