TECHNICAL ASSISTANCE FORM

Name: Mr. Mrs. Ms. ________________________Date of Initial Contact_____________

Home Phone: (        ) __________________ Work Phone (        ) ____________________

Project Address: ______________________________________ City: _________________

                 State: _________ Zip: _______________

Ward/Neighborhood (if in Cleveland): __________________ Age of Building: ________

Is Your Building Sided With:  Brick          Wooden Clapboards 
                                                    Wooden Shingles             Stucco
                                                    Other: _____________________________

Are the Building's Windows Original?  Yes   They Are Made of:  Wood   Metal
                                                        No  How Many Have Been Replaced? _________

What Do You Need Assistance With? ________________________________________

______________________________________________________________________

Will You Need Financing?   Yes     No

Mailing Address: _____________________________________City: ________________

                      State: __________ Zip: _____________

Other Comments or Questions? _____________________________________________

______________________________________________________________________

Complete and mail or fax this form to:

The Cleveland Restoration Society
3751 Prospect Avenue
Cleveland, Ohio 44115-2705
Phone: (216) 426-1000
Fax: (216) 426-0550
www.clevelandrestoration.org