North American Housing -

Information Request Form
(fill this form out to receive additional information)

Name:

Company Name:

Address:

City: State: Zip:

Phone (h): Phone (w):

Email: Fax:

How did you learn of North American Housing? (check all that apply)

Name of Newspaper:

Name of Home Magazine:

Name of Builder magazine:

Name of County Real Estate Guide:

Yellow Pages

Friend / Family

Other

What is your building background?

Years Building:
Licensed:		License # if applicable:

Have you ever worked with modular technology before:
Do you currently own lots?
Where do you currently build?

North American Housing Corp.
5724 Industry Lane Frederick, MD 21704
Phone: (301) 694-9100
Fax: (301) 694-7570
Email: sales@northamericanhousing.com