INFORMATION REQUEST FORM

To request information from The Gem Real Estate Group, Inc., please fill out the following form or contact Lisa Chaney at chaney@gemcompanies.com or fax your request to 937-228-4079.

Please note that The GEM Real Estate Group, Inc. reserves the right to charge a fee for the information provided.

1. Please provide the following contact information:

Name
Title
Organization
Work Phone
Fax
Email
URL

2. Please provide the following ordering information on your subject:

Subject Information (Required)

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

3. What kind of information are you requesting? (Required)

Improved Sales
Land Sales
Leases / Rents
Market Data
Other Information (Explain Below)

4. Type of Property:

5. Size of Property:

6. Square Footage:

7. Year Built:

8. Additional Information:

8. How did you learn of our Website?

The information conveyed is privileged and is intended only for the use of the individual(s) or entity(ies) named above. Be advised that any unauthorized disclosure, copying, distribution or taking of any action in reliance on the contents of this information and materials is strictly prohibited.

The individual(s) or entity(ies) named above agree to hold The Gem Real Estate Group, Inc. harmless from any /all liability which may result from the unauthorized use of the information described above.

No part of any publication may be reproduced, distributed or transmitted in any form or by any means electronic, mechanical, photocopy, recording or otherwise, without the prior written permission of The Gem Real Estate Group, Inc.

The Gem Real Estate Group, Inc. reserves the right to reject any or all requests for information in its sole discretion.