Go Green Home Game Giveaway Trenton

Sunday, 9/20/09
New England @ New York

First Name:*

Last Name:*

Address:*

Apt/Suite:

City:*

State:*

Zip:*

Birth Date:*

(mm/dd/yyyy)

Email:*

Confirm Email:*

Day Phone:*

How long have you owned your current home?

Less than 1-year
1 - 3 years
3 - 5 years
5 - 10 years
10+ years
Do not currently own a home

Do you need any of the home improvement projects completed in the next 12 months? (check all that apply)

Siding
Roofing
Windows
Gutters

What is the biggest problem with your home?

Leaky Roof
Clogged Gutters
Drafty Windows
High Energy Bills
Cold Rooms
Poorly Insulated Roof
Poorly Insulated Siding
Pealing Paint
Rotten Wood
Cosmetics / Change Look

Which of the following best describes you and your vision?

I am nearsighted (I see objects more clearly than distant objects).
I am farsighted (I see distant objects more clearly than close objects).
I have an astigmatism (objects are blurry regardless of distance).
Daily contact lens etc is a hassle and I would like to wake up and see clearly.

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