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Name: Phone: Address: Email: Please select from the following questions what is you status in relationship to the property?Home OwnerLandlordManagementRenterTenant Of The AreaOther, Explaiin Type Of PropertyHouseApartmentTown HouseOffice 1-3 FloorsOffice 4 Floors PlusSchoolManufacturing PlantRestaurantMedical FacilityAuto Machanic / BodyOther, Explain Age Of Dwelling ?1-3 Years3-6 Years10 Years20 Years30 Years40 Years50 Years + Other: Other: Has There Ever Been Water Damge On Your Premises Yes No If Yes, Then How Long Ago Please Describe The Damage Or Flood Incident Is There Any Visible Mold On Walls, Floors Or Ceilings ? SelectNOYes On The WallsYes On The CeilingsYes On The FloorsYes All Over The Place Is There A Smell Throughout The Property No Yes And It Smells LikeMoldSewerHumid Muggy SmellMoistureDusty Moist SmellRusty Pipe SmellDusty Dry SmellAn Unclean Smell On A Scale Of 1 - 10 How Bad Is The Smell Select1 Not Bad2345678910 Very Bad Do You Or Anyone Have Allergy Symptoms No Yes The Following DoInfant 1-4 Years OldChild 5-12 Years OldTeenager 13-19Adult 20=30Adult 30-40Adult 40-60Senior CitizenOnly Some Of UsAll Of Us DO Was A Physician Contacted About Your Symptoms No Yes Is Anyone Pregnant On The Premises? Yes No Has An Insurance Claim Been Filed ? If So, Who Is The Adjuster In What Rooms And On Which Floor Or Floors Do You Suspect Mold How Did You Hear About Us ?Google SearchYahoo SearchOther Internet SearchRecommendationNewspaperOur VansOther, Explain Others Comments, Questions etc..