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Paint The Town 2010 Registration
Owner Information
Name:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Neighborhood:
Phone Number:
Alternate Phone Number:
Owner's Age:
18-29
30-39
40-49
50-59
60-69
70-79
80-89
90+
Physical Disabilities (if any):
Total Annual Household Income (select one):
$0-$20,000
$20,000-$30,000
$30,000-$40,000
$40,000 and above
How did you hear about Paint The Town?
Friend/Family
Avondale Community Council
Evanston Community Council
Cincinnati Childrens Hospital and Medical Center
Library
TV
Other
Home Information
Do you own your home?
Yes
No
Do you live at the address on this application?
Yes
No
How long have you lived at this home?
1-4 years
5-10 years
11-15 years
16-20 years
20-25 years
25+ years
How many children are living at this household?
0
1
2
3
4
5
6+
Size of your home:
1-Story
2-Story
3-Story or more
Has the exterior of your home been painted?
Yes
No
How many years since the last time the exterior was painted?
Not Applicable
Don't Know
1-4 years
5-10 years
11-15 years
16-20 years
20-25 years
25+ years
Is the exterior of your home (check all that apply):
Wood Siding
Painted Brick
Stucco
Natural Brick
Aluminum Siding
Vinyl Siding
Trim Only
Other
Other Information:
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