Client Name:

Contact Person:

Position:

Address:

City:   State:   Zip:

Phone #:   Toll Free #:

Fax #:   E-Mail:

World Wide Web Address:

(1) What are the occupant symptoms?

(2) What is the age of the building?

(3) What is the size (square feet) of the building?

(4) What type of construction?

Concrete Block Frame Modular/Premanufactured Metal Other:

(5) How many stories is the building?

(6) What is the size and type of the air conditioning equipment?

(7) Is temperature and humidity under control?

YES NO

Average Temperature:

Average Humidity:

(8) What type of HVAC system in the building?:

(9) I would be interested in the following:

Ductwork/HVAC System Cleaning Mold Remediation ? drywall, furnishings Topical Cleaning ? walls ceilings, floors Environmental Chamber Cleaning e.g. books, files, furnishings Book and File Restoration Disaster Recovery Services Please have an account executive contact me to further discuss building issues