CHOICE SHEET OPTIONS:

FLOORING - Vinyl

Flooring: Gray^

Flooring: Dark Brown^

Flooring: Light Brown ^

FLOORING - Carpet:

Carpet: Honey Beige ^

Carpet: Flax Beige ^

Paint - Walls & Trim

Paint: Alabaster ^

Paint: Natural Linen ^

Paint: Navajo White ^

Paint: Match Existing ^

Cabinets:

Cabinet: White ^

Cabinet: Espresso ^

Cabinet: Gray ^

Countertops :

Countertop: White ^

Countertop: Light Tan ^

Countertop: Dark Tan ^

* if choosing "match existing", homeowner acknowledges while color matching is generally accurate it isn't always a perfect match.

Roofing - Shingles:

Shingle: Black ^

Ext. Walls: Hardie Board Siding, Soffit, & Fascia:

Paint: Natural Linen ^

Paint: Navajo White ^

Paint: Alabaster ^

Paint: Match Existing ^

Ext. Walls: Vinyl Siding, Soffit, & Fascia:

Color: Sand ^

Color: Sterling ^

Color: Linen ^

Restore Louisiana Choice Sheet

Please complete this form to make the selections for your home.

Reference the Choice Sheet Options above.

Baton Rouge Choice Sheet

Full Name:

Email Address:

Phone:

Address:

Program ID:

Flooring (Living Room):

Flooring (Bedrooms):

All Rooms Paint Colors:

Trim / Doors Paint Color

Cabinets (Kitchen):

Cabinets (Bathroom):

Countertops:

Exterior Walls: Hardie Color:

Soffit / Fascia Trim (for Hardie):

Exterior Walls: Vinyl Siding:

Soffit & Fascia Trim (for Vinyl):

Kitchen Appliance Color:

ADA Bathroom Location:

Doctor's Note Provided?

Driveway Location:

Water Supply:

Water Company (if applicable)

Sewage Waste:

Sewer Company (if applicable):

Septic Tank:

Septic Tank Location (if applicable):

Sewage Treatment Tank Needed?

Roofing: Shingles

Electric Company:

Gas Company (if applicable):

Opt-In

By checking the box I understand - the above selections are the selections that the above homeowner has picked to be installed in their house for the Restore Louisiana Program. These materials will be economic grade materials that comply with the program requirements.

Signature -Homeowner' s Signature - by typing my name below I agree that this shall be an electronic representation of my signature when I use it to sign this document - just the same as a pen - and - paper signature.

Electronic Signature:

Field label

Please Note: