"COMPETING FOR YOUR SAVINGS, EVERYDAY"

ATX

FULL NAME ( FIRST NAME, LAST NAME)
ADDRESS (#, STREET NAME, CITY, STATE, ZIP CODE)
PHONE
DOB (XX/XX/XX)
YEAR BUILT OF THE HOME (If unknown, leave it blank)
SQUARE FEET OF THE HOME
HOME VALUE ($)
AGE OF ROOF (Years old)
DOES THE HOME HAS A CHIMNEY?
DOES THE HOME HAS A POOL?
WHAT HEATING SYSTEM THE HOME HAS? (CENTRAL, BURNING STOVE, OTHER)
TYPE OF CONSTRUCTION: FRAME, BRICK, MASONRY, STUCCO. (If unknown, leave it blank)
WHO LIVES IN THE HOME (OWNER OCCUPIED - TENANT - OTHER)
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