Buyer Name 

E-Mail Address  

Daytime Telephone  

Other Phone or Fax Number  

1. How did you hear about our company?   Yellow Pages Brochure Business Card Agent Referral Friend Referral Other Website Company Website ASHI Website Newspaper Advertisement Other   

 * If referred, please let us know who to thank! 

 *If through an ad, where did you find it? 

2. What type of home is to be inspected?   Residential Multi Family Condominium Mobile Home Apartment Building Commercial Building

3. What is the age of the home?  

4. What is the square footage?  

5. How many bedrooms?   One Two Three Four Five Six More Than Six

6. How many bathrooms?   1 1.5 2 2.5 3 3.5 4+

7. What city in Ohio is the home in?  

8. What county is the home in?  Summit County Stark County Portage County Medina County Cuyahoga County Wayne County

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