The foundation of my home is: *

The total square footage of my home is: *

My source of heat in the winter is: *

My source of conditioned air in the summer is: *

I am concerned about/notice: *

I have experienced “ice dams” during the winter: *

I have pets: *

I’ve done the following in the past 5 years: *

I have the following floor covering in my home: *

Number of occupants who suffer asthma / allergy symptoms, including seasonally: *

Anything else you feel is important for us to consider?