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Name:
*
Address 1:
*
Address 2:
City:
*
State:
*
Zip Code:
*
Phone Number:
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Email:
*
On a yearly basis my utilities average over $160 a month:
*
True
False
My windows now:
*
Let in a lot of heat in the summer
Leak air
No longer open or will no longer stay open
Have damaged or missing screens
Need repair
Other
I plan to keep my home:
*
less than 3 years
3-5 years
5-7 years
7 years or more
Unsure
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Name:
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Address:
City:
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Area Code / Phone:
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Age of Home:
How Long You've Lived In Your Home:
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1-5 years
6-10 years
11-20 years
21-30 years
31-50 years
50+ years
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