First and Last Name             

  Street Address                     

  City                                      

  State                                                                             

  Zip Code                              

  Phone Number                      

  E-mail address                     

  Check if address of the property same as mailing address   Yes   

  Address of the property                       

  City, State, Zip code                            

  Number of bedrooms      0 1 2 3 4 5 6        Number of full bathrooms  0 1 2 3 4         Half bathrooms  0 1 2 3

  Approximated sq. ft.                                   

  Size of the yard                                            Less then .05 .05 - 1 acre 1 - 5 acres More then 5 acres

  Approximated age of the structure              

  How long have you owned this property    

  Front Porch                 Yes     No                         Deck                       Yes    No

  High ceilings               Yes     No                        Hardwood floors     Yes    No

  Irrigation System         Yes     No                        Central Vacuum       Yes    No 

  Alarm system              Yes      No                       Screened Porch        Yes    No

  Waterfront                   Yes      No                       Golf Course             Yes    No

  Garage                         Single       Double        Triple       Detached 

  Heating source             Heat pump    Gas pack   Water source heat pump   Other 

  POA Dues                    Yes     No                     If yes annual dues 

  Please list all the improvements that you made to the property

 Please let us know if there is anything else that might be pertinent to your property value.