Please provide the following information: 

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Request Data on what residential property address?	136 E. Fourth St. 126 N. Bell St. - Bradner 6727 N. County Road 3 6020 CR 62 - Kansas 747 Cherry St. 204 Elm St. 2511 Fostoria Road 818 E. Fremont St. 322 W. Guthrie St. - Upper Sandusky 2405 Hawthorne Dr. 188 Huss - Tiffin 429 W. Jackson St. 38 Main St - Tiffin 936 N. Main St. 134 W. Main St - Wayne 333 W. North St. 162 Nelson St - Clyde 811 Oak Park 825 Oak Park Dr. 727 Oaklawn Ave. 445 Park Ave #401 674 N. Poplar St 9659 W. SR 12 4447 S. State Route 12 - Tiffin 701 Stinchcomb Dr. 70 N. SR 587 9329 W. TR 57 364 Thomas St. 1220 N. Union St. 1401 Van Buren St #27 645 Van Buren St. 341 N. Vine St. 1016 N. Vine St. 843 Walnut St. 308 Wooster St. - Bowling Green
Request Data on what commercial property address?	304 N. Main St. 109-113 S. Main St. 11480 W TR 116
Request Data on what land  address?	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