Website Compliance Intake SurveyThank you for supplying OptiRev with all the proper ADA compliance information we need to list on your website!Business InformationLet's start by getting some basic information about you and your business.Business Name*Full Name* First Last Email Address* Phone NumberThis will be a call-back number, so please include a direct phone-line.Property Address*We need the physical/mailing address of the property. Street Address Address Line 2 City CAAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Website URL*Please submit a survey for each individual property/website. Did you complete the "Website Compliance Disclosure Agreement"?* I did not receive it / I did not sign it. I received, understand, signed and returned the "Website Compliance Disclosure Agreement".Wheelchair AccessibilityThe following questions apply to all questions apply to publicly accessible spaces, or private spaces you provide patrons access to. It does not include restricted areas exclusively for employees/staff.Wheelchair & Handicap ParkingDoes your property or the surrounding roads within a 1 mile radius have clearly identifiable handicap parking spots? Yes, on-site handicap parking spaces are available on our property. Yes, off-site handicap parking spaces are available on public property. No, there's no handicap accessible parking nearby. Wheelchair Accessible Shared SpacesWhich of the following features do you have in any of your general shared spaces? Lobby/Reception area has low-rise counters, desks, and/or table-tops available. Wheelchair accessible restrooms are available in these spaces.Wheelchair Accessible ElevatorsDo you have wheelchair accessible elevators which reach all levels from the ground-floor? Yes, and it accommodates a wheelchair. Yes, but it does not accommodate a wheelchair. No, we do not have an elevator and our upper floors are inaccessible by wheelchairs. N/A—our building is ground floor only. Wheelchair Accessible RoutesDo you have wheelchair accessible doorways, walk-ways, hallways, indoor-routes, etc.? Yes, all doorways and/or walk-ways are wide enough to fit a wheelchair. No, all doorways and/or walk-ways are too narrow to fit a wheelchair. Wheelchair Accessible Vehicles Yes, our shuttle(s) and/or vehicle(s) have a wheelchair accessible ramp/lift. Yes, our shuttle(s) and/or vehicle(s) have a wheelchair accessible ramp/lift; however, this must be requested in advance. Yes, but they are not wheelchair accessible. N/A—we do not provide a shuttle or vehicular service. Wheelchair & Handicap Accessible ImagesUpload images of each ADA-compliant parking spot(s), entrance(s), exit(s), space(s), route(s), or vehicle(s) to visually present these features. Please make sure the image files are properly named so we know what feature is which. Drop files here or Select filesAccepted file types: jpg, png, pdf, Max. file size: 128 MB.Regarding Service AnimalsAll questions apply to publicly accessible spaces, or private spaces you provide patrons access to. It does not include restricted areas exclusively for employees/staff.Service Animal PermissionAccording to “Title II of the ADA”, service animals are permitted on our property with no imposed costs/fees. Agree We provide a fully-refundable deposit Disagree Service Animal DamagesIf any damages are caused by the service animal, a fee of $______ may be charged.Additional Features for Service AnimalsDo you provide any other/additional accommodations for service animals?Seeing & Hearing Impaired AccessibilityAll questions apply to publicly accessible spaces, or private spaces you provide patrons access to. It does not include restricted areas exclusively for employees/staff.Features for the Seeing-ImpairedDo you provide any other/additional accommodations for the seeing-impaired?Features for the Hearing-ImpairedDo you provide any other/additional accommodations for the hearing-impaired?ADA Compliant Lodging FacilitiesThese questions pertain to businesses such as: hotels, motels, hostels, and other forms of lodging facilities. If your place of business does not provide these products/services to customers, please skip this.List of ADA-Compliant RoomsPlease list each room type, what accessibility feature(s) it has, and the quantity of that room.For example:Premium King RoomRoll-In Shower3Queen SuiteBed-Side Lift, In-Shower Seat1RoomFeaturesQuantity Guest Room / Bathroom ImagesUpload images of every ADA-compliant guest bedroom and bathroom to visually present the features listed above. Please make sure these image files are properly named so we know which room is which. Drop files here or Select filesAccepted file types: jpg, png, pdf, Max. file size: 128 MB.General Facility / Amenity ADA-Compliant FeaturesPlease add facility features which are available at your business.For example: Swimming Pool(s) with accessible ladders/steps General Facility / Amenity ImagesUpload images of every ADA-compliant facility and/or amenity to visually present these features. Please make sure these image files are properly named so we know what is what. Drop files here or Select filesAccepted file types: jpg, png, pdf, Max. file size: 128 MB.Website Terms of ServiceWe will be placing our standard Terms of Service ("TOS") policies on your website. If you would like to request any modifications to the policies please indicate them below:Please make the following revisions to our Website TOS:Final QuestionsAdditional InformationDid we miss something? Please let us know if there are any additional accessibility features at your business.Additional MediaIf you have additional photos, documents, or videos you'd like us to implement on your website regarding ADA compliancy features please upload them here. Please make sure the image files are properly named so we know what feature is which. Drop files here or Select filesMax. file size: 128 MB.For 3rd Parties*A copy of this survey will be emailed to you at the address you provided for your convenience. It's your responsibility to deliver this information to any other business entities that will need to display this information (such as booking engines, reservation systems, or other websites) managed by them. I understand and agreeThank You!We will review your completed survey and implement the information on your website. We'll contact you once it's completed. Afterwards, we highly recommend you have a legal advisor verify your website provides enough information to be ADA compliant.FeedbackWe want to do the best we can! Is there anything we can do to improve this process?Consent to Personal Data Collection* I agree to the website privacy policy and consent to my personal data being collected.ΔWebsite Compliance Intake Survey was last modified: September 27th, 2018 by optirev