Have you
ever been the victim
of a disaster or theft? |
Yes No |
How many
openings does your
house or businessplace have? |
Number of doors
Number
of garage doors
Number of windows |
| Do you own
an alarm system? |
Yes No |
When you
moved into your
present residence, did you have
the keys changed? |
Yes
No |
Which
district do
you live in? |
|
What type of
residence
do you live in? |
Apartment
Duplex, triplex
Cottage, bungalow |
Please
complete if you would
like us to get in touch with you: |
Name
Telephone |
| |
|