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NOTE: REPORTS ARE NOT SENT UNTIL PAYMENT OF INVOICE HAS BEEN RECEIVED AND VERIFIED BY ENVIROAPPRAISAL-THANK YOU

ORDER SERVICES

PAYMENT NOTE: ALL ORDERS WILL RECEIVE AN INVOICE SHORTLY AFTER SUBMISSION

Property Address *

Number of Bedrooms *

Township *

Expected Closing Date

Tax ID

OWNER/BUYER INFO

Name *

Cell/Mobile Phone

Home Phone

Owner/Buyer Address

REALTOR INFO

Name

Company

Email *

Mobile/Cell

Alt Phone Number

Fax

Mailing Address

Contact for service needs/arrangements

If other, who?

Send report via

PROPERTY INFO

Is there electric power?

Yes No

Is the property vacant?

Yes No

If yes, how long?

Services Requested - NOTE THERE IS A $100.00 MAX RETURN FEE if we have to return to property to re-inspect septic or well due to inaccessibility or incomplete inspection first visit, could not get in, resample water well, check isolations, no power or water available first visit, etc. No hidden fees, includes travel and transaction fees

Septic Only (Includes: "Locate And Expose Septic System" - $325.00 (Travel Fee if over 40 miles may be added) Well Only - (Includes: Bacterial/Nitrate samples) - $275 (Travel Fee if over 40 Miles may be added) Septic and Well (Includes: "Locate And Expose Septic System" and Bacterial/Nitrate Samples) - $385.00 (Travel Fee if over 40 miles may be added) Dewinterize/Rewinterize - $109.00 per well Locate, Expose and Diagram Septic System - $200.00/hr., 1 hour min. Lead Water Analysis (7-10 Day Turnaround by STATE of MI Lab) - $159.00 Arsenic Water Analysis (7-10 Day Turnaround by STATE of MI Lab) - $159.00 Nitrites (if requested, there is an additional 40.00 lab fee, check with underwriter/loan officer) - $40.00 Sewer Line Scope - check line from house to private septic or public sewer - $225.00 Sample Well or City Water - includes bacteria/nitrate sample - $109.00 (Travel Fee if over 40 Miles may be added)

Has the home been winterized?

Yes No

House dewinterized and ready to sample?

Yes No

Keybox/Combination Code

Date of Submission

Additional Information

If septic evaluation, how long ago was septic tank/tanks pumped?

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