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ORDER SERVICES
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
Owner
Realtor
Broker
Other
If other, who?
Send report via
Email
Postal Mail
Fax
PROPERTY INFO
Is there electric power?
Yes
No
Is the property vacant?
Yes
No
If yes, how long?
Services Requested
Septic Only (Includes: "Locate And Expose Septic System") - $225.00
Well Only - (Includes: Bacterial/Nitrate samples) - $225.00
Septic and Well (Includes: "Locate And Expose Septic System" and Bacterial/Nitrate Samples) - $325.00
Dewinterize/Rewinterize - $75.00/well
Locate, Expose and Diagram Septic System - $150.00/hr., 1 hour min.
Pump Septic Tank - $250-275.00/1000 gal. (Charged by Pumper)
Lead Water Analysis (7-10 Day Turnaround by Michigan EGLE) - $23.00
Arsenic Water Analysis (7-10 Day Turnaround by Michigan EGLE) - $23.00
Nitrites (if requested, there is an additional 20.00 lab fee, check with underwriter/loan officer) - $20.00
Has the home been winterized?
Yes
No
House dewinterized and ready to sample?
Yes
No
Keybox/Combination Code
Travel Fee (Outside 20 Mile Radius)
*
Allegan - $25.00
Barry - $0.00
Berrien - $35.00
Branch - $25.00
Calhoun - $0.00
Cass - $25.00
Hillsdale - $35.00
Ionia - $35.00
Kalamazoo - $0.00
Kent - $35.00
Newaygo - $50.00
Muskegon - $50.00
St Joseph - $25.00
Van Buren - $15.00
Payment
*
Credit Card (immediate payment online with CC info)
Completion of Service
Date of Submission
Additional Information
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