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Your Contact Information  (Please complete all fields)   First Name: Last Name: Cell Phone: Daytime Phone: Evening Phone:   EMail: Street Address: City: State/Province: Zip/Postal Code:

Are you looking to evaluate your homes value for the purposes of selling or refinancing?     Selling Refinancing If you are planning to sell your home, will it be within the next 6 months?     Yes No

Description of the home you wish to sell:

Style of Home:  (eg. 2 levels, 1 level, bungalow, backsplit, etc.)   Type of Home   Detached Semi-detached Link Townhouse-Freehold Townhouse-Condo Condo Other Approximate Square Footage:   Lot Size: ft. Frontage x  ft. Depth Location:   Type of Heating:   GAS OIL ELECTRIC OTHER Age of Home:   Number of Bedrooms:   1 2 3 4 5 More Number of Bathrooms:   1 1.5 2 2.5 3 3.5 4 More Fireplaces:   YES NO MULTIPLE Finished Basement:   YES NO No Basement   On a scale of 1-10 (with 1 being Poor and 10 being Exceptional), please rate the showability of your home: Poor 1 10 Exceptional   Special Features: