New Client Profile Form

Please fill out this form in its entirety for each structure you wish to be considered for consultation.

Contact Information

Property Owner First Name

Property Owner Last Name

Email Address

Work Number

Home Number

Cell Number

Best Number to Call

Best Time To Call

Owner's Mailing Address

Address 2

City

State

ZIP

Co-Owner(s)

Preferred Method of Payment

Property and Structure Information

Same as Owner's Address

Property Address

Address 2

City

State

ZIP

Tax Parcel ID

Date of Construction

Purchase Date

Total Square Footage

Elevator

Number of Stories

Name of the closest water body or flooding source on the Flood Insurance Rate Map (FIRM)

Check the Applicable Description for Each of the Following Categories

Structure Type
Single Family
2-4 Family
Other Residential
Non-Residential

Flood Insurance Information

Do You Have A Current Flood Policy? Yes No

Insurance Company

Agent Name

Phone Number

Policy Age

Policy Number

Elevation Certificate? Yes No

Floodproofing Certificate? Yes No

Please complete if your building is elevated on crawlspace, solid foundation walls, piers, post, piles or columns and/or has an attached garage. The statement must be signed by the insured/client.

Policy Number

Insured Name

Property Address

Overall Structural Questions

Constructed on
Piles, posts or piers
Columns
Parallel shear walls
Solid perimeter walls

Have there been any additions to the original structure? Yes No

Have there been major renovations or additions to the structure? Yes No

Number of elevators

Enclosure or Crawlspace

Dimensions

Feet wide by

feet deep

OR total square footage

Is the enclosure partitioned or divided into separate rooms? Yes No

Vents & Openings

Number of permanent openings (excluding doors/garage doors & windows) within 1 foot of the ground

totaling square inches.

Date vents installed:

The enclosure/crawl space is enclosed using:
Insect screening/lattice
Certified breakaway walls
Solid wood frame walls
Concrete block/brick/masonry walls
Other

What is the enclosure is used for? What year was it built?

Enclosure Details	Yes	No
Is drywall in place that is mudded, taped, and painted?
Is there plywood painted covering any wall, either partially or fully?
Does the area contain habitable space, living areas or bathrooms (half or full)?
Have finishes been installed like carpeting, tile flooring, etc.?
Is the area used for any other purpose other than parking, storage or building access?
Is there an elevator below the BFE?
Is the enclosed area equal to or greater than 300 square feet and the structure is located in a V-Zone?

What machinery and equipment servicing the building is located inside the enclosure. (e.g.: Elevator car and/or equipment, Hot water heater, Washer & dryer)

Attached Garage

Dimensions

Feet wide by

feet deep

OR total square footage

Vents & Openings

Number of permanent openings within 1 ft. of ground

Square inches of vents

Date vents installed

Attached Garage Details	Yes	No
Is drywall in place that is mudded, taped, and painted?
Is there plywood painted covering any wall, either partially or fully?
Does the area contain habitable space, living areas or bathrooms (half or full)?
Have finishes been installed like carpeting, tile flooring, etc.?
Is the area used for any other purpose other than parking, storage or building access?
Is there an elevator below the BFE?
Is the enclosed area equal to or greater than 300 square feet and the structure is located in a V-Zone?

What machinery and equipment servicing the building is located the garage. (e.g., Hot water heater, Washer & dryer, etc.)

Client's Goals