Home Surfaces Questionnaire

Green Home Makeover

Personalized Green Home Maintenance Manual for those who live outside Southern Oregon. Detailed information on how to save money and energy while making your home environment safer and healthier for you and your family. Learn the best products to use and what to definitely not use.

To receive your personalized Home Maintenance Manual, fill out the following questionnaire, pay $50 with Pay Pal and your manual will be promptly mailed to you. Please be as specific as possible about what is in your home. For example, if you have carpet, please specify what type e.g. nylon, wool, etc.

Name:

Email:

Mailing Address:

Phone Number:

Kitchen: Type of Countertops/Floors:

Bathroom: Type of Countertops/Floors/Bathing Area:

Living Room: Type of Floor:

Hallways: Type of Floor:

Bedrooms: Type of Floors:

Office: Type of Floor:

Basement/Rec Area: Floor Type:

Any Other Areas: Type of Floors/Countertops:

When was your home built?:

Has it been remodeled since?:

What cleaning products are you currently using?:

What type of heating/cooling does your home have?:

How much south-facing window area do you have, if any?:

How much west-facing window area do you have, if any?:

Do you have curbside recycling?:

What do you currently recycle, if anything?:

Special Requests:

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Home Surfaces Questionnaire