Name  *  Date 

Address *

City, St Zip    * ,    *

Home Phone          Work Phone  

        E-mail  *

   * Required

Yes, Larson Customer (project/when)

            referred by  or received a  T/M Phone call Flier Door AD Yellow pages Other

1.      Whole house inspection completed? No Yes : if Yes when      

        Corrections needed? No Yes    (If Yes, describe in comments)

2.      At this address, which room(s) are you using most of the time? 

Why?

3.      What living area limits are present in your home today? 

   The living area limits to our home are?

4.      How would remodeling or a home improvement project provide more usable area? 

  Make our living area more usable?

5.      Describe what home improvement is most important to you: (Select ONE)

      Roofing Gutters Custom Trim Gutter Protection Siding Kitchen Update Bathroom Update Windows Replaced Room Addition

ÿ Roofing (see below) ÿ Gutters ÿ Trim ÿ Gutter Covers ÿ Siding (see below) ÿ Kitchen ÿ Bathroom

ÿ Windows (see below)   ÿ Room Addition (see below)

The above home improvement(s) should be completed by:

with an expected cost of   $

Do you have estimate(s) for this home improvement? No Yes   from    Larson Home Improvement

and/or:                 

6.      Your roof is (approximately)  years old?

Asphalt/Fiberglass shingle

        Two layer or more tear off? No Yes Not Sure

Wood Shake Rolled Roofing Other

7.      Present home Siding is? Aluminum  Vinyl   Wood (IE.. Cedar, Redwood, etc...)

                                                How Many?       What type?

8.      Desired windows are:            Double Hung

  Slider

  Awning

  Casement

  Other

9.      Room Addition desired length (Ft.)  and width (Ft.)       One Two   Story 

                 Constructed to the Rear Front North East West South Side of home.    Roof type Gable Hip Shed Other

        Room will be:  Bedroom Family Great Rm Area Kitchen Bathroom Sunroom Enclosed Porch Other_Room_Type

        Bedroom ÿ Family ÿ Kitchen ÿ Bath ÿ Sunroom ÿ Enclosed Porch ÿ Other              

At this address, how long have you been the homeowner?  Years 

Is the property co-owned?  No Yes Not Sure   If Yes, owned with Spouse Sole Property Owner Other Owner(s)  

Can Larson Home Improvement make a follow up e-mail visit or phone call                                                                                    (Select all that apply)

Comments:

  Whole house inspection home improvement correction(s)

Thank you for you cooperation

 Larson Home Improvement        

Author RDL  
Copyright © 2005 Larson Home Improvement/Larson Aluminum sales, Inc.  All rights reserved.
Revised: November 29, 2007