Real Estate Inspection Request Form | Blue Ridge Termite and Pest

Agent Use Only

Ordered By*

Phone*

Closing Date*

Request Fax of Report? *

Select One*

Type of Loan*

Agent*

Agency/Company*

Phone*

Fax Number*

Lawyer/Closing Company*

Phone*

Fax Number*

Lawyer/Closing Company Address*

Street Address Address Line 2 City State ZIP Code

Seller’s Name

Phone(H)

Phone(W)

Cell

Buyer’s Name

Phone(H)

Phone(W)

Cell

Inspection Address*

Street Address Address Line 2 City State ZIP Code

Type of Structure*

Other Structures

Property Access*

Other Access Method

If Other, please explain

Lock Box Combination Code

Additional Information/Directions

Type of Inspection*

Water Analysis*