SCHEDULE AN INSPECTION
Request Form

Last Name:
First Name:
Daytime Phone Number:
Evening Phone Number:
Current Mailing Address:
Property to Inspect Address:

SERVICES REQUESTED
Home Inspection
Yes
No
Wood Pest Inspection
 Yes
No
Radon Test
Yes
No
Water Test
 Bacteria Only
Bacteria & Chemical
Conventional
New FHA
VA
Other
Other Services:

BUYER'S AGENT

Agent Name:
Company:
Address:
Phone:
Cell:
FAX:
Home:
LISTING AGENT
Agent Name:
Company:
Address:
Phone:
Cell:
FAX:
Home:
COMMENTS:
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4359 Linglestown Rd.  |  Harrisburg, PA 17112
PHONE: 717-920-8230  |  FAX: 717-920-8240