May 20, 2012
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First & Last Name
Mailing Address
Mailing Town & Zip code
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DE
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IA
ID
IL
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,
Building Address is the mailing Address
Phone Numbers
Home:
Work:
ext:
Cell:
Building Street Address
Building Town & Zip Code
,
MA
ME
NH
NY
VT
,
Building Dimensions
Wide
ft x
Lenght
ft x Hieght
1 Story
1.5 Story
2 Stories
2.5 Stories
3+ Stories
Number of Chimneys
0
1
2
3
4
5
Building Foundation
Slab (no Basement)
Concrete Wall
Stone/Brick Wall
Concrete Pillars
Other
If you have a basement, what is the height?
1 Foot
Between 1 to 3 Feet
4 to 6 Feet
Over 6 feet
What are you plan to do with the building?
New foundation To replace current foundation
Just Supporting the building while repairs
Move to new location on the current property
Move to new location which is on a different property
Other
Anything else about the building?
Desired Start and Finished Dates
Start Date
January
February
March
April
May
June
July
August
September
October
November
December
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17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
,
2010
2011
2012
Finish Date
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
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31
,
2010
2011
2012
Email Address
(Example: JoeHomeOwner@Email.com)
Messier House Moving & Construction, Inc. ©2008-2012
Website created by Norman L. Messier Jr.