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* 1. Please provide your name and address:

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* 2. If known, please provide the original construction date of your house:

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* 3. If you have undertaken renovations, please check each of the following that best describes the work:

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* 4. Select any of the original features, materials, or finished that remain in your house.

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* 5. Please indicate if you would be willing ot have your house surveyed. The process takes less than two hours and the information is used for research and informational purposes only and will not be made public.

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* 6. Additional contact information:
Phone Number and e-mail

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