EML PHASE I REQUEST FORM

Name of Potential Client:                                                     _______________________________________

Address:                                                                                _______________________________________

                                                                                                _______________________________________

Client Contact:                                                                      _______________________________________

Telephone Number:                                                             (         )__________________________________

Fax Number:                                                                         (         )__________________________________

E-mail Address:                                                                    _______________________________________

Phase I Property Name:                                                       _______________________________________

__ Commercial      __ Industrial       __ Residential

Address of Property:                                                           _______________________________________

                                                                                                _______________________________________

Approximate Acreage:                                                        ___________________     __ acres   __ square feet

Approximate Square Feet of Improvements:                  ________________________________________

Financing (if applicable):

• Bank Name/Address:                                           ________________________________________

• Other Financial Entity:                                        ________________________________________

Comments: _________________________________________________________________________               

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________                                                      

(for EML use only)

Fee Proposed:                                                                       _________________________________________

Proposal Accepted:                                                              __ Yes                                      __ No

If No, Reason For Rejection:                                              _________________________________________

Report Sent:                                                                          Date: _________   How Mailed: _________

Invoice Sent:                                                                         Date: _________   Fee: _________