Repeat test form • Core Solutions

Property Address:	Actions

There are no Properties.

Who Referred You?:*

Owner Information / Report Prepared For:

Entity Name:*

Contact Mailing Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact Information:

Contact Name:*

Contact Title:

Company:

Contact Phone:

Contact Email:*

Property Information:

Property Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Building Type / Usage:*

(e.g., apartments, auto dealership, office etc)

Building Square Footage:*

Number of Buildings:*

Real Estate Information:

Do you own or Lease the building?:*

Own
Lease

Building Type / Usage:*

(e.g., apartments, auto dealership, office etc)

Purchase Price / Construction Cost:*

Purchased Date:*

Major Renovation Cost:

Has the Renovations / Construction Been Completed?

Yes
No

Renovation Completion Date:

Only enter date if renovations are completed

Does the Company Own Multiple Properties?:

Yes
No

Annual Utility Spend:

Annual Property Tax:

Business Information:

Type of Business:

Number of Employees:

Annual Revenue:

OWNER INFORMATION / REPORT PREPARED FOR:

PROPERTY INFORMATION:

ENGINEERING STUDIES REQUESTED:

REQUIRED COST SEGREGATION INFORMATION CHECKLIST: