1. Your Name:

2. Do You Often Experience Cold Spots?

Choose One... Yes No Sometimes, but not always.

3. Do you sometimes see shadows that move from one side of the room to another?

Choose One... Yes No Sometimes, but not always.

4. Do you sometimes see a dark mass move from one side of the room to another?

Choose One... Yes No Sometimes, but not always.

5. Do you sometimes seem to place items one place and then not be able to find them and then they reappear the next day or two?

Choose One... Yes No Sometimes, but not always.

6. Do you sometimes at night or during the day hear footsteps in your home and no one but you is there?

Choose One... Yes No Sometimes, but not always.

7. Do you sometimes hear your name called out and no one is there?

Choose One... Yes No Sometimes, but not always.

8. Do you sometimes hear a tapping noise in the walls or somewhere through your house?

Choose One... Yes No Sometimes, but not always.

9. Does your child talk to someone and no one is there that you can see?

Choose One... Yes No Sometimes, but not always.

10. Does the animals in your home seem to be frightened, or to go into a particular room of your house?

Choose One... Yes No Sometimes, but not always.

11. Do you feel someone is watching you?

Choose One... Yes No Sometimes, but not always.

12. Do you feel another presence in the house and you are the only one there at that moment?

Choose One... Yes No Sometimes, but not always.

13. Do doors open and close in your home by themselves?

Choose One... Yes No Sometimes, but not always.

14. Name of the TRUE Home Owner:

15. Street Address of Paranormal Activity Location:

City:

State:

Province/Territory:

(Only if country is not United States.)

ZIP or Postal Code:

Country:

Choose One... United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic ChadChile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D Ivoire Croatia Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands FijiFinland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard And Mc Donald Islands Honduras Hong Kong Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati South Korea Kuwait Kyrgyzstan Lao Peoples Republic Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway OmanPakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts And Nevis Saint Lucia Saint Vincent And The Grenadines SamoaSan Marino Sao Tome And Principe Saudi ArabiaSenegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia The South Sandwich Islands Spain Sri Lanka St Helena St Pierre and Miquelon Suriname Svalbard And Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic TaiwanTajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States US Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis And Futuna Islands Western Sahara Yemen Yugoslavia ZaireZambia Zimbabwe

16. Contact Phone Numbers:

Home Phone (Include Area Code):

Cellular Phone (Include Area Code):

Additional Contact Number (If applicable, Please Include Area Code):

This phone number belongs to:

17. E-Mail Address:

Can we include your e-mail address for our e-newsletter?

Choose One... Yes No

18. Additional Contact Information (The Best Way To Contact You):

19. Description of paranormal activity, and why you are requesting a paranormal investigation:

Thank you!  Please press the button below to submit your investigation request to our Case Manager!  You will be contacted shortly.