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Real Estate Service

All Orders Are Confirmed !
Please complete all necessary information

Ordered By:
Date Ordered:
Settlement Date:
Papers Needed:
 

Service(s) Requested

Termite (Wood Destroying Insect Inspection)
Conventional well test (Standard e-coli & Coliform Bacteria)
FHA/VA well test (Lead, Nitrate, Nitrite, PH and turbidity)
Septic Dye and Walkover Inspection*
Radon (available in Maryland only)

 
Note: All fields will accept information beyond the size of the boxes below.
Please include first and last names.
Ordering Agent:
First Name: Last Name:
Home#: Work#: Cell#:
Fax#: Email:
 
Other Agent:
First Name: Last Name:
Home#: Work#: Cell#:
Fax#: Email:
 
Property Address:
City: State: Zip Code:
 
Buyers Name
First Name: Last Name:
Phone #1: Phone #2:
 
Sellers Name
First Name: Last Name:
Phone #1: Phone #2:
 
Scheduling Instructions:
 
Lock Box Code: Or E-Key: yes no
 
Papers To:
Name: Phone #:  Fax #: 
Address:
City: State:  Zip Code: 
 
Settlement Company:
Name: Phone #:  Fax #: 
Address:
City: State:  Zip Code: 
 
 
 

Pricing Guide:
Termite $35.00 Septic $55.00 Radon(MD Only) $80.00
Well $95.00 MD/PA Conventional $245.00 MD/PA FHA/VA $115.00
VA Conventional $340.00        

Click here to print a blank form
Form can be faxed to 888-797-4009