Name:
Phone:
Fax:
Email:
Occupation:

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Type of Shelter Construction:
	Steel Tank
	Reinforced Concrete

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Type of Protection:
	Fallout
	Blast
	NBC
	EMP Shielding

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Number of Occupants:
	Adults:	Select 0 1 2 3 4 5 6 7 8 9
	Children:	Select 0 1 2 3 4 5 6 7 8 9

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Square footage requirements
(UBC Minimum 50 SF per person)
We suggest a minimum of 200 sq ft per person.

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Power Sources:
	Wind Generator:	yes no
	PV panels:	yes no
	Gas Generator:	yes no
	Diesel Generator:	yes no
	Public Utility:	yes no

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Storage
	Water Storage Potable Gallons:
	Fuel Storage Type:
	Gallons:
	Food Storage Capacity:	1 year 2 year 3 year 4 year 5 year

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Accessories
	Greenhouse:	yes no
	Root Cellar:	yes no
	Laundry:	yes no
	Recreation Area:	yes no
	Full Spectrum Lighting:	yes no
	Storage Room:	yes no
	Communications:	yes no
	Weather Observation:	yes no
	Security Observation:	yes no
	Decontamination Room:	yes no
	Additional Emergency Egress:	yes no

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Proximity from:
	Airports:	Miles
	Military Base:	Miles
	Nuclear Arsenal:	Miles
	Chemical Arsenal:	Miles
	Nuclear Power Plant:	Miles

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Location for Shelter:
	Next to House
	Remote Property

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For Survey Customers only:
Would you like to arrange a tour of an existing Facility:
Yes:
No:

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Specific Info Requested: