Order A Residential System Design Survey

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Size: Select an Option One Two Three Four Five Six Seven Eight Nine Ten Eleven Twelve Thriteen Fourteen Fifteen Children less than 2 Yrs: Select an Option One Two Three Four Five Six Seven Eight Nine Ten Eleven Twelve Thirteen Fourteen Fifteen Zero

Pets: Select One Yes No My Pets are: Select One Small Medium Large Not Applicable

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Telephone: Select One No Phone lines Cell Phone(s) Only Standard Line Service Voice Over Internet Protocol Computer: Select One Yes No

Fax: Select One Yes No Internet Access: Select One No Internet Access Cable Dial-Up Modem DSL Modem Satellite

Please check all areas of interest that apply:

Fires Burglaries and Hold ups Medical Emergencies Carbon Monoxide Poisoning Flood Pipes Freezing Personal Safety High Value Asset Protection 24-Hour Monitoring Car Theft Vandalism

Please select below all that apply:

Residence: Select One Condo Row Home Separated Lot Gated Community Townhouse Multi-family Home Business Residential Apartment Building Commercial Office Building Floors Select One One Two Three Four Five Six Seven Eight Nine Ten Eleven Twelve Thirteen Fourteen Fifteen Sixteen Seventeen Eighteen Nineteen Twenty

Doors Select One One Two Three Four Five Windows Select One Zero One Two Three Four Five Six Seven Eight Nine Ten Eleven Twelve Thirteen Fourteen Fifteen Sixteen Seventeen Eighteen Nineteen Twenty More Than Twenty

Please select all that apply:

Front Select One Wood Metal Glass Wood & Glass Metal & Glass Rear Select One None Wood Metal Glass Wood & Glass Metal & Glass

Side Select One None Wood Metal Glass Wood & Glass Metal & Glass Porch Select One Wood Metal Glass None Wood & Glass Metal & Glass

Basement Select One None Wood Metal Glass Wood & Glass Netal & Glass Garage Select One None Wood Metal Glass Wood & Glass Metal & Glass

Please check or select all that apply:

Backyard Access Select One None Public Access from Alley Private Alley Access Access from Public Wooded Area Access from Private Wooded Area Access from Main Street

Front Door to Sidewalk Select One Less than 20 Feet 20 to 30 Feet 31 to 40 Feet 41 to 50 Feet More than 50 Feet Rear Door to Gate Select One Less than 20 Feet 20 to 30 Feet 31 to 40 Feet 41 to 50 Feet More than 50 Feet

Skylight Fencing Select One No Fence Low Fence High Fence Tree and Shrubbery Fencing Barbed Wire Fencing Wooden Fence Roof Hatch Yes No

Garage Select One Connected to Home Separated from Home None Garage Size Select One One Car Two Cars Three or More Cars None

Please select your schedule preference for the Residential System Design Survey.

Month: Select One January February March April May June July August September October November December Day: Select One Monday Tuesday Wednesday Thursday Friday Saturday Time Slot: Select One 8:00 -Noon Noon- 4:00PM 4:00 - 7:00PM