Please provide the following information: 

    NOTE: TO SELECT MULTIPLE ITEMS HOLD DOWN CTRL

Request Data on what residential property address?	2341 Brandeberry Road 350 W. Center St. 909 Cory St. 8522 W CR 28 332 Elm St. 821 Elmhurst 2209 England Road 1113 Girton Rd. 607 Hart Ave 699 Hart Ave. 844 Hurd Ave-Findlay 407 Lonna 235 E. Lytle St. 527 N. Main St. 2131 McCutcheonville Rd. 1365 Muirfield 1371 Muirfield 333 W. North St. 803 Oak Park 811 Oak Park 813 Oak Park 428 Ohio 1371 Pelton 1020 Rock Drive 425 Union Ct. 214 W. Tiffin St. 1398 N. Union St. 1695 N. Union St. 23141 US RT 224; Alvada 601 N. Vine St.
Request Data on what commercial property address?	304 N. Main St. 1321 Perrysburg Rd 155 E. South St.
Request Data on what land  address?	1315 Walnut St. Hissong St. Lots Corner of 47 & 84 Independence Ave. Lots Loudon Estates Lots
First Name
Last Name
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone:
Office Phone:
Fax
E-mail
Please tell us a little about yourself:
What type of home to you prefer?	Ranch Cape Cod Two-Story Duplex Tri-Level Split-Level
Number of Bedrooms?	2 3 4 5+
Number of Bathrooms?	1 1.5 2 2.5 3+
Garage type?	None 1 Car Attached 1 Car Detached 2 Car Attached 2 Car Detached 3+ Car Attached 3+ Car Detached
Are you interested in selling your current home?	Yes No
Location?	Rural Urban Suburban
What price range do you fall under?	$0-$24,999 $25,000-$49,999 $50,000-$74,900 $75,000-$99,999 $100,000-$124,900 $125,000-$149,999 $150,000-$174,999 $175,000-$199,999 $200,000 & Up
How did you hear about American Heritage Realty?	Radio Advertisement Newspaper Advertisement Home Buyer Guide Advertisement Surfing the web Friend, Family Member, Word of Mouth Someone told me about the web site Repeat Customer Drive-By Other