Rep Name
*
First Name
*
Last Name
*
Address
*
City
*
State
*
Postal code
*
Phone
*
Email
*
Utility Provider
*
Average Electric Bill
*
$
# of Years in Home
*
Shade
*
No Shade
Minimum Shade
Medium Sahde
Heavy Shade
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Roof Type
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Comp/Asphalt Shingles
Tile Roof
Spanish Clay Tile
Woodshake
Metal
Flat
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Age of Roof
*
Household Income
*
$
Credit Score
*
Credit Repair
*
Yes
No
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Debt Amount
Type of Debt
Notes
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