| First Name |
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| Last Name |
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| Street Address |
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| City |
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| State |
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| Zip |
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| Home Phone |
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| Cell Phone (if different) |
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| Email Address |
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| What type of home do you live in? |
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| Do you own or rent your
home? |
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| If you rent, please provide your
Landlord's name and phone number: |
Landlord Name:
Landlord Phone:
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| Are you full-time residents of
Arizona or snowbirds? |
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| How many adults in your
household? |
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| How many children in the
household, and what age? |
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| Do you have a doggie door
big enough for a Great Dane? |
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| Do you have a fenced yard? |
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| What type of fence do you have? |
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| What is the height of your fence, at
the lowest point? |
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Do you have locks and/or
latches on all your gates? If no gates, select N/A |
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| Do you have an in-ground pool? |
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| If yes, is the pool fenced? |
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| Please define your household:
(Check all that applies) |
Busy (visits by friends, children, parties)
Noisy (TV, stereo, machinery, tools, children playing)
Moderate (normal comings and goings)
Quiet (Homebodies, few guests, stay home a lot)
Live on a quiet cul-de-sac
Lots of children in neighborhood
Live on a busy street or highway
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| Do you have any pets at this time? |
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| If Yes, please provide the following information: |
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