Intake Form - House

Company Name

Name *

First

Last

Email *

Phone

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Lot Dimension

How Many levels do you want your House to have?

• Single
• 2 level
• 3 level

Design of the house:

• Modern
• Traditional

Number of bedrooms:12345 or more

Number of full washrooms:12345 or more

Balcony:

• Yes
• No

Garage:

• Yes
• No

2 car or 3 car garage.

• 2
• 3

Type of Roof:

• Flat
• Sloped

Laneway:

• Yes
• No

What type of Laneway:

• Single
• 1.5

Laneway: Number of bedrooms -12345 or more

Laneway: Number of washrooms - 12345 or more

Laneway: Balcony -

• Yes
• No

Laneway: Type of roof -

• Flat
• Sloped

Laneway: Garage

• Yes
• No

Engineer:

• Globe Geotech
• Other (Please Specify)

Engineer Name *

First

Last

Email *

Phone *

Arborist:

• Klimo & Associates
• Other (Please Specify)

Arborist Name *

First

Last

Email *

Phone

Energy Advisor:

• Airtight Energy Reports
• Other (Please Specify)

Advisor Name *

First

Last

Email *

Phone

Comments:

File Upload

* .dwg file format

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