I NEED PLANNING ASSISTANCE, LET’S BEGIN Please complete the form below. Asterisks (*) indicate fields are required.
	Name:*
	PHYSICAL ADDRESS
	Street:*		HELP: ##### - NAME - STREET DESIGNATION <e.g. please do not forget - Dr., St., BLVD., Ct., Loop, etc.>
	City:*
	State:*		-Select- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
	Zip code:*
	Phone:*
	Email:*		HELP: Under our license state law requires we send you consumer information AND all our planning assistance is email bound so you have a complete "written" record of our service and planning promises...
	DESCRIBE PROPERTY
	Are you the owner:		Yes Owner's Representative Tenant Leasee HELP: Check all that apply.
	Property built year:		(YYYY)
	Year residency at property:		(YYYY-YYYY_MM) HELP: Year owner or resident began residency at this property.
	Approx. Square Footage:		(#####)
	Foundation Type:		Slab Pier & Beam Both HELP: Check all that apply.
	DESCRIBE CHALLENGE
	Nature of Moisture Loss:		High RH Leak - Roof System None Leak - Plumbing System Leak - Unidentified Source HELP: Please provide information describing the nature of any moisture or water intrusion. Check all that apply.
	Visible Contamination:		AC Registers (vents) - in supply box and or duct line AC Registers (vents) - on cover AC System (AHU) - on seals Cabinets Crawlspace None AC Registers (vents) - on ceiling adjacent AC System (AHU) - in return Attic Ceilings Walls
	Odor:		-Select- Yes No
	Allergies or symptoms:		Asthma Chemical Allergies Seasonal Allergies Blood Toxicity None HELP: Allergies or other symptoms. Check all that apply.
	Testing requested:		Yes No HELP: Check all that apply.
	First noticed issue:		(YYYY_MM_DD)
	Our customer notes:		HELP: Please provide customer perspective, observations, history notes, information on a resident's special health concerns, etc.
	Our customer availability:		HELP: To empower us to meet "your" scheduling requirement please share the best time for initial call/review AND your requirement for a site visit, best day, best times, etc.
	YOUR SPECIAL INSTRUCT.
	Property meetup contact:*		HELP: Contact who will meet us at the property.
	Contact person phone #:
	Parking:		HELP: Please provide any gate codes, location, special requirements you want us to follow.
	Are you a robot?:* CAPTCHA		Enter image text or refresh page.
			Privacy Notice: INFORMATION PROVIDED WILL NEVER be used for marketing purposes or shared without express permission of the customer. This is a promise from my family to yours.
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