Name:


Address (Street, City, State and Zip):


Email Address:


Phone Number:


Cell Phone:

List Household Occupants (names, ages, relationships:


Location Type:
Home Business

Age of Building:
1 - 10 10 - 20 40 - 60 20 - 40 Over 50 Over 100 Over 150 Years

Please list known previous owners (names, phone numbers)


Known history of the building or previous owners:

Number of floors:   Number of rooms:

Has there been any recent remodeling?
Yes No

Please indicate if you have experienced any of the following activity (check all that apply):

Unexplainable odors:
Unexplainable sounds
Unexplainable movement/disappearance of objects:
Unexplainable problems with electrical appliances
Unexplainable problems with plumbing
Unexplainable problems with pets:
Trouble with sleeping and/or nightmares:

Describe the phenomenon you are experiencing in the home
(Please provide as much detail as possible)

Do you feel that the phenomenon is evil or threatening in any way?
Yes No

Has there been any contact with any of the following?
Media Clergy Another Paranormal Research Group

Please provide any additional information you feel is
necessary to evaluate your situation:

 

Once the form is completed, please hit "Submit".  A representative will be in contact with you within 24 hours.