Full Name

E-mail

Mobile Phone (123-456-7891)

Are you the owner on title of the home you are inquiring about today? Are you the owner on title of the home you are inquiring about today? yes No, If no, please provide the following information:

Homeowners Name:

Degree of relationship with the homeowner: Degree of relationship with the homeowner:SpouseSon/DaughterParentSiblingOther

I have power of attorney and can legally represent the homeowner. I have power of attorney and can legally represent the homeowner. Yes. *The Power of Attorney is a legal requirement and official proof must be provided to proceed. no

Address | (#, Street, Town/City, Province, Postal Code (XXX-XXX)

Size of Home (Ft.²)

How many years have you owned this Home?

Ownership Status - Owned Outright? Ownership Status - Owned Outright? Yes No

Number of Years Remaining on Mortgage?

Second Mortgage or Liens on Home? Second Mortgage or Liens on Home? Yes No

Please highlight the renovation categories that you believe your home is most in need of: Please highlight the renovation categories that you believe your home is most in need of: Flooring Roof Siding and Exterior Finishing Kitchen Bathroom Drywall Basement Finishing Sectioning (Creation of Separate Dwelling) Water Damage Structural Damage/Weakness Plumbing Electrical Insulation Paint Landscaping Deck Garage Windows Mold Foundational Damage ( large cracks etc.)

Please add any additional explanation regarding your home and what it needs:

Have you performed any renovations to date? Have you performed any renovations to date? Yes No

If yes, please list details.

Appx $ Value of All Renovation Performed

Current Desired Sale Price

Agree to terms and conditions Agree to terms and conditions Yes No