Please Fill Out ALL Information Below
Canvasser Name —Please choose an option—Gregg MillsBob FreyGordon BergFrank Van AuskasMary FloresRuby SenivaDanyal SuchtaAldrich BernardoHanna BaileyEva PerryCassandra ScibienskiDana PeasleyAngelica Palafox PachecoDeborah HicksJason SantosNickolas FredricksonCori GolubicsMaher AbdeenZachary CoalmonBarbara EnglandAndrita ChavezBill PonathTrevor TaylorBenjamin CleavelandDaniel ScottAndrew CortezRichelle SimpsonCasey CochranRoger ReynagaAmber ZollSammy FallasTyler MatthewsDustin Mincheski
Zone—Please choose an option—Zone 1Zone 2Zone 3Zone 4
Date Lead Obtained
Time Lead Obtained
Customer Last Name
Customer First Name 1: (The person you spoke to)
Customer First Name 2:
Street Address
City
Zip Code
Phone Number
How Many Windows?
How Many Sliding Patio Doors?
How Many French Doors?
How Many Entry Doors?
How long have they owned the home? (MINIMUM OF 6 MONTHS)
Do they plan on selling the home in the next 2 years? (DO NOT SUBMIT IF THEY ARE SELLING)—Please choose an option—YesNo
Major Cross Streets:
Additional Notes:
