HCS Survey

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Home Phone*

Cell Phone

Email*

What type of building do you live in?*

HDFC Cooperative Multifamily Rental Multifamily Cooperative Multifamily Condominium 1-4 Family Non-profit Governmental Commercial

I am a*

Building Board Member Building Resident/Tenant Property Manager Building Owner

Is your co-op a member of the Urban Homestead Assistance Board (UHAB.org)?

Yes No I don't know

Are you a member of or worked with Cooper Square Committee in the past (coopersquare.org)?

Yes No I Dont Know

Number of units in the building

Roof age:*

How old is your roof? When (approximately) was it last replaced?

Roof Condition

Do you have any plans to replace or modify your roof in the near future?

How did you hear about us?*

Please specify (if applicable)

Questions/Comments