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Member #
First Name
Middle
Last Name
Home Phone
Cell Phone
Work Phone
Member Email
Associate #
First Name
Middle
Last Name
Work Phone
Cell Phone
Home Phone
Assoc. Email
Zip Code
City
State
Street #
Street
Street Type
Unit Type
Unit #
Section A. - Property Details
Type
Primary Residence
Business Office
Business Retail
Business Shop
Business Garage
Vacation Home
Investment Property
Second Home
Other (See Notes)
# Of Floors
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
M
Entry Level
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
M
Yr Built (Appx)
Pre 30
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Newer
# Bedrooms
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Mor
# Of Baths
1
1.5
2
2.5
3
3.5
4
4.5
5
5.5
6
6.5
7
7.5
8
8.5
9
9.5
M
# Kitchens
1
2
3
M
Roof Typ/Mat
Asphalt Shingle Pitched
Flat Roof Membrane
Gravel Flat Roof
Metal Roof Flat & Tar
Pitched Metal Roof
Tile Clay Roof
Other (See Notes)
Siding Typ/Mat
Brick
Cement Board/Hardi
Vinyl Siding
Stucco On Block
Stucco On Board
Wood Painted
Metal/Aluminum
Concrete Block
Other (See Notes)
Drive/Pkg Mat
Asphalt - Black/Grey
Concrete
Paving Stone
Stone/Gravel
Grass Lane
Dirt
Other (See Notes)
Yr Windows In
Pre 30
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Newer
Yr Doors In
Pre 30
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Newer
Garage Info
No Garage(s)
1 Single Car
2 Single Car
3 Single Car
4 Single Car
M Single Car
Double Car Door (1)
3C -Combo Drs (For 3)
4C -Combo Drs (For 4)
5C -Combo Drs (For 5)
6C -Combo Drs (For 6)
7C -Combo Drs (For 7)
8C -Combo Drs (For 8)
MC - Combo for More
Ceilings
Flat
Texture
Other (See Notes)
HVAC Access.
Air Purifier (AP)
Bacteria Light (BL)
Dehumidifier (DH)
Mini-Split Sys (MS)
Window Unit (WU)
Zone System (ZS)
AP & BL
AP & DH
AP & MS
AP & WU
AP & ZS
BL & DH
BL & MS
BL & WU
BL & ZS
DH & MS
DH & WU
DH & ZS
MS & WU
MS & ZS
WU & ZS
AP, BL & DH
AP, BL & MS
AP, BL & WU
AP, BL & ZS
AP, DH & MS
AP, DH & WU
AP, DH & ZS
AP, MS & WU
AP, MS & ZS
BL, DH & MS
BL, DH & WU
BL, DH & ZS
DH, MS & WU
DH, MS & ZS
MS, WU & ZS
(See Notes)
# HVAC Syst
1 One
2 Two
3 Thr
More
Section B - HVAC System 1
Type
Split System
Package Unit Out
Inside Contained
Other (See Notes)
Tons
1 Ton
1.5 Ton
2 Ton
2.5 Ton
3 Ton
3.5 Ton
4 Ton
4.5 Ton
5 Ton
More
Thermostat
Dial
Slider
E-Programmable
Zone Programs
Other (See Notes)
TStat Brand
Accustat
Ambient
AUB
Braeburn
Bryant
Cadet
Carrier
Emerson
Hawking Tech
Honeywell
Hunter
Jackson Sys
Lennox
Lux
Rheem
Robertshaw
Steren
TPI/Emerson
White Rodgers
White-Westingh
Other
TStat Model
Condenser Brand
Adams
Addison
Aire-Flo
Amana
American Standard
Arcoaire
Axeman-Anderson
Ariston
Armstrong
Biasi
Bryant
Buderus
Burnham
Carrier
Central Boiler
Centurion
Clare
Coleman
Columbia
Comfortmaker
Daikin
Dayton
DeLonghi
DMO Industries
Dornback
Ducane
Dunkirk
Emerson
Evcon
Fedders
Friedrich
Frigidaire
Fulton
General Electric
Gibson
Glowcore
Goldstar
Goodman
Haier
Hallmark
Hamilton Engineering
Heil
Homart
Intertherm
Janitrol
Keeprite
Kenmore
Kerr
Laars
Lennox
Luxaire
Maytag
Mitsubishi
Munchkin
Newmac
Olsen / Airco
Oneida Royal
Parker
Payne
Peerless
Pennco
Polaris
Rheem
Ruud
Samsung
Sanyo
Sears
Sharp
Slant/Fin
Spartan
Tappan
Tempstar
Thermal Solutions
Thermo Pride
Trane
Trianco
Utica
Viessmann
Weatherking
Weil-McLain
Whirlpool
Williamson-Thermaflo
York
Other
Condenser Model
Condenser Serial
Air Hand Brand
Adams
Addison
Aire-Flo
Amana
American Standard
Arcoaire
Axeman-Anderson
Ariston
Armstrong
Biasi
Bryant
Buderus
Burnham
Carrier
Central Boiler
Centurion
Clare
Coleman
Columbia
Comfortmaker
Daikin
Dayton
DeLonghi
DMO Industries
Dornback
Ducane
Dunkirk
Emerson
Evcon
Fedders
Friedrich
Frigidaire
Fulton
General Electric
Gibson
Glowcore
Goldstar
Goodman
Haier
Hallmark
Hamilton Engineering
Heil
Homart
Intertherm
Janitrol
Keeprite
Kenmore
Kerr
Laars
Lennox
Luxaire
Maytag
Mitsubishi
Munchkin
Newmac
Olsen / Airco
Oneida Royal
Parker
Payne
Peerless
Pennco
Polaris
Rheem
Ruud
Samsung
Sanyo
Sears
Sharp
Slant/Fin
Spartan
Tappan
Tempstar
Thermal Solutions
Thermo Pride
Trane
Trianco
Utica
Viessmann
Weatherking
Weil-McLain
Whirlpool
Williamson-Thermaflo
York
Other
Air Hand Model
Air Hand Serial
Line Length
25'
50'
75'
100'
125'
Othr
Section C - HVAC System 2
Type
Split System
Package Unit Out
Inside Contained
Other (See Notes)
None
Tons
1 Ton
1.5 Ton
2 Ton
2.5 Ton
3 Ton
3.5 Ton
4 Ton
4.5 Ton
5 Ton
More
TStat Type
Dial
Slider
E-Programmable
Zone Programs
Other (See Notes)
TStat Brand
Accustat
Ambient
AUB
Braeburn
Bryant
Cadet
Carrier
Emerson
Hawking Tech
Honeywell
Hunter
Jackson Sys
Lennox
Lux
Rheem
Robertshaw
Steren
TPI/Emerson
White Rodgers
White-Westingh
Other
TStat Model
Condenser Brand
Adams
Addison
Aire-Flo
Amana
American Standard
Arcoaire
Axeman-Anderson
Ariston
Armstrong
Biasi
Bryant
Buderus
Burnham
Carrier
Central Boiler
Centurion
Clare
Coleman
Columbia
Comfortmaker
Daikin
Dayton
DeLonghi
DMO Industries
Dornback
Ducane
Dunkirk
Emerson
Evcon
Fedders
Friedrich
Frigidaire
Fulton
General Electric
Gibson
Glowcore
Goldstar
Goodman
Haier
Hallmark
Hamilton Engineering
Heil
Homart
Intertherm
Janitrol
Keeprite
Kenmore
Kerr
Laars
Lennox
Luxaire
Maytag
Mitsubishi
Munchkin
Newmac
Olsen / Airco
Oneida Royal
Parker
Payne
Peerless
Pennco
Polaris
Rheem
Ruud
Samsung
Sanyo
Sears
Sharp
Slant/Fin
Spartan
Tappan
Tempstar
Thermal Solutions
Thermo Pride
Trane
Trianco
Utica
Viessmann
Weatherking
Weil-McLain
Whirlpool
Williamson-Thermaflo
York
Other
Condenser Model
Condenser Serial
Air Hand Brand
Adams
Addison
Aire-Flo
Amana
American Standard
Arcoaire
Axeman-Anderson
Ariston
Armstrong
Biasi
Bryant
Buderus
Burnham
Carrier
Central Boiler
Centurion
Clare
Coleman
Columbia
Comfortmaker
Daikin
Dayton
DeLonghi
DMO Industries
Dornback
Ducane
Dunkirk
Emerson
Evcon
Fedders
Friedrich
Frigidaire
Fulton
General Electric
Gibson
Glowcore
Goldstar
Goodman
Haier
Hallmark
Hamilton Engineering
Heil
Homart
Intertherm
Janitrol
Keeprite
Kenmore
Kerr
Laars
Lennox
Luxaire
Maytag
Mitsubishi
Munchkin
Newmac
Olsen / Airco
Oneida Royal
Parker
Payne
Peerless
Pennco
Polaris
Rheem
Ruud
Samsung
Sanyo
Sears
Sharp
Slant/Fin
Spartan
Tappan
Tempstar
Thermal Solutions
Thermo Pride
Trane
Trianco
Utica
Viessmann
Weatherking
Weil-McLain
Whirlpool
Williamson-Thermaflo
York
Other
Air Hand Model
Air Hand Serial
Line Length
25'
50'
75'
100'
125'
Othr
Section D - HVAC System 3
Type
Split System
Package Unit Out
Inside Contained
Other (See Notes)
None
Tons
1 Ton
1.5 Ton
2 Ton
2.5 Ton
3 Ton
3.5 Ton
4 Ton
4.5 Ton
5 Ton
More
TStat Type
Dial
Slider
E-Programmable
Zone Programs
Other (See Notes)
TStat Brand
Accustat
Ambient
AUB
Braeburn
Bryant
Cadet
Carrier
Emerson
Hawking Tech
Honeywell
Hunter
Jackson Sys
Lennox
Lux
Rheem
Robertshaw
Steren
TPI/Emerson
White Rodgers
White-Westingh
Other
TStat Model
Condenser Brand
Adams
Addison
Aire-Flo
Amana
American Standard
Arcoaire
Axeman-Anderson
Ariston
Armstrong
Biasi
Bryant
Buderus
Burnham
Carrier
Central Boiler
Centurion
Clare
Coleman
Columbia
Comfortmaker
Daikin
Dayton
DeLonghi
DMO Industries
Dornback
Ducane
Dunkirk
Emerson
Evcon
Fedders
Friedrich
Frigidaire
Fulton
General Electric
Gibson
Glowcore
Goldstar
Goodman
Haier
Hallmark
Hamilton Engineering
Heil
Homart
Intertherm
Janitrol
Keeprite
Kenmore
Kerr
Laars
Lennox
Luxaire
Maytag
Mitsubishi
Munchkin
Newmac
Olsen / Airco
Oneida Royal
Parker
Payne
Peerless
Pennco
Polaris
Rheem
Ruud
Samsung
Sanyo
Sears
Sharp
Slant/Fin
Spartan
Tappan
Tempstar
Thermal Solutions
Thermo Pride
Trane
Trianco
Utica
Viessmann
Weatherking
Weil-McLain
Whirlpool
Williamson-Thermaflo
York
Other
Condenser Model
Condenser Serial
Air Hand Brand
Adams
Addison
Aire-Flo
Amana
American Standard
Arcoaire
Axeman-Anderson
Ariston
Armstrong
Biasi
Bryant
Buderus
Burnham
Carrier
Central Boiler
Centurion
Clare
Coleman
Columbia
Comfortmaker
Daikin
Dayton
DeLonghi
DMO Industries
Dornback
Ducane
Dunkirk
Emerson
Evcon
Fedders
Friedrich
Frigidaire
Fulton
General Electric
Gibson
Glowcore
Goldstar
Goodman
Haier
Hallmark
Hamilton Engineering
Heil
Homart
Intertherm
Janitrol
Keeprite
Kenmore
Kerr
Laars
Lennox
Luxaire
Maytag
Mitsubishi
Munchkin
Newmac
Olsen / Airco
Oneida Royal
Parker
Payne
Peerless
Pennco
Polaris
Rheem
Ruud
Samsung
Sanyo
Sears
Sharp
Slant/Fin
Spartan
Tappan
Tempstar
Thermal Solutions
Thermo Pride
Trane
Trianco
Utica
Viessmann
Weatherking
Weil-McLain
Whirlpool
Williamson-Thermaflo
York
Other
Air Hand Model
Air Hand Serial
Line Length
25'
50'
75'
100'
125'
Othr
Section E - Electrical Info
Panel Location
Panel Brand
Ademco
AEMC
Alt E M3
Ancor
Blue Sea
Braindex
Carrier
Cutler Hammer
Delta
Eaton
GE
Gen-Tran
Honeywell
Infratech
Magnetek
Newmar
OutBack
Pro/Tran
Ready Solar
Reliance
Square D
Tripp Lite
Watt
Xantrex
Zoeller
Other (Notes)
Panel Model
Panel Capacity
# Of Circuits
Type Wiring
Copper
Aluminum
Other
Subpanel Info
# Of Ceiling Fans
Std Switch Type
Ivory Std
Ivory Decora
White Std
White Decora
Brown Std
Brown Decora
Black Std
Black Decora
Other
Std Outlet Type
Ivory Std
Ivory Decora
White Std
White Decora
Brown Std
Brown Decora
Black Std
Black Decora
Other
Section F - Plumbing / Water Heater Info
# Of Waterheat Systms
0
1
2
3
M
WH1 Location
WH1 Brand
AO Smith
Bosch
Eemax
GE
HHP
Kenmore
LG Elec
Noritz
Paloma
Powerstar
Reliance
Rheem
Rinnai
Santon
Steibel Eltron
Takagi
US Craftmaster
Whirlpool
Other
WH1 Type
Tank - Gas
Tank - Electric
Inline - Gas
Inline - Electric
Boiler
Other
WH1 Capacity
WH1 Gas?
Yes
No
WH1 Yr In (Appx)
Pre 60
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Newer
WH2 Location
WH2 Brand
AO Smith
Bosch
Eemax
GE
HHP
Kenmore
LG Elec
Noritz
Paloma
Powerstar
Reliance
Rheem
Rinnai
Santon
Steibel Eltron
Takagi
US Craftmaster
Whirlpool
Other
WH2 Type
Tank - Gas
Tank - Electric
Inline - Gas
Inline - Electric
Boiler
Other
WH2 Capacity
WH2 Gas?
Yes
No
WH2 Yr In (Appx)
Pre 60
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Newer
Section G - Pest Control Info
Pest Control Plan Inside
PC Plan Outside
Pest Problems Now?
Pest Problem Notes
Section H - Fridges Info
# Of Fridges
0
1
2
3
M
Fr1 Location
Fr1 Brand
Amana
Blue Air
Continental
Frigidaire
GE
Haier
Hotpoint
Kitchen Aid
LG Elec.
Marvel
Maytag
Panasonic
Samsung
Sanyo
Scotsman
Summit
True
U-Line
Whirlpool
Zenith
Other
Fr1 Type
1 Door Upright
2 Door Upright
Bar Fridge
Bottom Freezer
Commer. Chest
Commer. Glass
Patio Fridge
Side By Side
Other
Fr1 Model
Fr1 Serial
Fr1 Capacity
Fr1 Yr New (Appx)
Pre 60
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Newer
Fr1 Notes
Fr2 Location
Fr2 Brand
Amana
Blue Air
Continental
Frigidaire
GE
Haier
Hotpoint
Kitchen Aid
LG Elec.
Marvel
Maytag
Panasonic
Samsung
Sanyo
Scotsman
Summit
True
U-Line
Whirlpool
Zenith
Other
Fr2 Type
1 Door Upright
2 Door Upright
Bar Fridge
Bottom Freezer
Commer. Chest
Commer. Glass
Patio Fridge
Side By Side
Other
Fr2 Model
Fr2 Serial
Fr2 Capacity
Fr2 Yr New (Appx)
Pre 60
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Newer
Fr2 Notes
Fr3 Location
Fr3 Brand
Amana
Blue Air
Continental
Frigidaire
GE
Haier
Hotpoint
Kitchen Aid
LG Elec.
Marvel
Maytag
Panasonic
Samsung
Sanyo
Scotsman
Summit
True
U-Line
Whirlpool
Zenith
Other
Fr3 Type
1 Door Upright
2 Door Upright
Bar Fridge
Bottom Freezer
Commer. Chest
Commer. Glass
Patio Fridge
Side By Side
Other
Fr3 Model
Fr3 Serial
Fr3 Capacity
Fr3 Yr New (Appx)
Pre 60
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Newer
Fr3 Notes
Section I - Ranges / Ovens / Cooktops Info
# Of Ovens/Micros
Ov1 Location
Ov1 Brand
Amana
American Range
Avanti
Black & Decker
Bosch
Cuisinart
Delonghi
Dacor
Danby
Electrolux
Frigidaire
GE
Goldstar
Haier
Hamilton Beach
Hotpoint
Jenn-Air
Kenmore
Kitchen Aid
LG
Maytag
MicroFridge
Panasonic
Sanyo
Sharp
Vulcan-Hart
Whirlpool
Commercl Other
Other See Notes
Ov1 Type
Range 4Elec Burnrs
BI Single Oven
BI Double Oven
Microwave Oven BI
Microwave Oven SA
Range Glass Top
BI Oven Rangetop
BI Oven Glasstop
BI Oven Conv Combo
Commercial Combo
Commecial Oven(s)
Other (See Notes)
Ov1 Model
Ov1 Serial
Ov1 Cooktop Info
Ov1 Yr New (Appx)
Pre 60
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Newer
Ov1 Notes
Ov2 Location
Ov2 Brand
Amana
American Range
Avanti
Black & Decker
Bosch
Cuisinart
Delonghi
Dacor
Danby
Electrolux
Frigidaire
GE
Goldstar
Haier
Hamilton Beach
Hotpoint
Jenn-Air
Kenmore
Kitchen Aid
LG
Maytag
MicroFridge
Panasonic
Sanyo
Sharp
Vulcan-Hart
Whirlpool
Commercl Other
Other See Notes
Ov2 Type
Range 4Elec Burnrs
BI Single Oven
BI Double Oven
Microwave Oven BI
Microwave Oven SA
Range Glass Top
BI Oven Rangetop
BI Oven Glasstop
BI Oven Conv Combo
Commercial Combo
Commecial Oven(s)
Other (See Notes)
Ov2 Model
Ov2 Serial #
Ov2 Cooktop Info
Ov2 Yr New (Appx)
Pre 60
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Newer
Ov2 Notes
Ov3 Location
Ov3 Brand
Amana
American Range
Avanti
Black & Decker
Bosch
Cuisinart
Delonghi
Dacor
Danby
Electrolux
Frigidaire
GE
Goldstar
Haier
Hamilton Beach
Hotpoint
Jenn-Air
Kenmore
Kitchen Aid
LG
Maytag
MicroFridge
Panasonic
Sanyo
Sharp
Vulcan-Hart
Whirlpool
Commercl Other
Other See Notes
Ov3 Type
Range 4Elec Burnrs
BI Single Oven
BI Double Oven
Microwave Oven BI
Microwave Oven SA
Range Glass Top
BI Oven Rangetop
BI Oven Glasstop
BI Oven Conv Combo
Commercial Combo
Commecial Oven(s)
Other (See Notes)
Ov3 Model
Ov3 Serial #
Ov3 Cooktop Info
Ov3 Yr New (Appx)
Pre 60
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Newer
Ov3 Notes
Cooktop Other Notes
Section J - Dishwasher Info
DW Location
DW Brand
Ariston
Blomberg
Bosch
Dacor
Danby
Electrolux
Fisher
Frigidaire
GE
Hotpoint
KitchenAid
LG
Maytag
Rack-Master
Traex Company
Whirlpool
Other
DW Type
Front Load 24" (Trad)
Hi Efficiency 24"
Hi Efficiency 18"
Portable Roll 24"
Portable Roll Other
Commercial Rack
Other
DW Model
DW Serial
DW Yr New (Appx)
Pre 60
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Newer
DW Notes
Section K - Laundry Machine Info
Washer Location
Washer Brand
Ariston
Asko
Bosch
Broan
Creda
Edgestar
Electrolux
Epic
Equator
Fisher
Frigidaire
GE
Haier
Kenmore
LG Electronics
Maytag
Samsung
Summit
Whirlpool
Other
Washer Type
Top Load (Trad)
Front Load
Stacked Frt Load
Stacked Top Load
Other -See Notes
Washer Model
Washer Serial #
Washer Yr New (Appx)
Pre 60
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Newer
Washer Notes
Dryer Location
Dryer Brand
Ariston
Asko
Bosch
Broan
Creda
Edgestar
Electrolux
Epic
Equator
Fisher
Frigidaire
GE
Haier
Kenmore
LG Electronics
Maytag
Samsung
Summit
Whirlpool
Other
Dryer Type
Front Load (Trad)
Top Load
Stacked Frt Load
Stacked Top Load
Other -See Notes
Dryer Model
Dryer Serial #
Dryer Yr New (Appx)
Pre 60
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Newer
Dryer Notes
Section L - Freezer Info
Freezer Location
Freezer Brand
Avanti
Engel Coolers
Frigidaire
GE
Haier Appliances
Kelvinator Comm
Summit
Sunpentown
Traulsen
United
Whirlpool
Other
Freezer Type
Chest-Res.
Chest-Comm.
Chest-CommOpen
Upright-Res.
Upright-Comm.
Upright-Glass Dr.
Other
Freezer Model
Freezer Serial #
Freezer Yr New (Appx)
Pre 60
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Newer
Freezer Notes
Section M - Notes, Photos, & CSR Info
Photos - Email In
Report Notes
Assigned CSR #
First Name
Middle
Last Name
Zip Code
City
State
Work Phone
Cell Phone
Home Phone
Email
Report Date
Today's Date