Termite Inspection Request

Date Ordered: Time: Inspection Date:
Inspector: License #:
Time In: Time Out:
Bill/Fax to Escrow: Bill to Realtor:

Realty Company: Phone:
Ordered By: Fax:
Seller/Owner: (full name) Phone:
Buyer: (full name) Phone:

Complete Jobsite Address:
Vacant: Lock Box #:
Previously Fumigated: Date:
Company: Warranty: (# years)
Ground Treated: Warranty: (# years)
Company: Sentricon: (date)

Complete All Information
Escrow Company: Closing Date: Phone:
Mailing Address: Fax:
City/State: Zip:
Escrow Officer: Escrow #:
Lender: Phone: Fax:
Mailing Address:
Loan Officer: Financing:
Type: Condo House Townhouse Commercial Bedrooms:
Reason: Selling Refinancing Relocating
Schedule Appt. With: Phone:
* NOTE: INSPECTION VALID FOR 15 DAYS FROM DATE OF INSPECTION