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Reshop Intake TEST
Step
1
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2
50%
Name
(Required)
First and Last Name
Phone Number
(Required)
What's the best number to reach you at?
Email Address
(Required)
What is the best email address to have on file for you?
Policies to Review
(Required)
Home
Auto
Other
Check all that apply!
Home Information
Is there a pool on the premises?
No
Yes
Is it enclosed (fenced)?
No
Yes
Is there a removable diving board and/or slide?
No
Yes
Do you have any children?
No
Yes
What is the age of your roof?
Have there been any updates to the home?
For example, added square footage, remodeled kitchen and/or bathrooms, etc.
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