Who do you represent? Buyer Seller Agent

Agent's Information

First Name:

Last Name:

Email Address :

Phone # :

Alt Phone # :

Buyer's Information

First Name:

Last Name:

Phone # :

Alt Phone # :

Seller's Information

First Name:

Last Name:

Phone # :

Alt Phone # :

Property Information

Street Address:

City:

State:

Zip:

Property Type:
Townhouse Single Family Home Condominium Duplex

Other:

Settlement Information

Settlement Date:

Company:

Phone #:

Fax #:

Entry Information

Is there a lockbox?
Yes No

If Yes, is it vacant?
Yes No

If No, who do we contact for entry?
Buyer Seller Agent

Additional Comments:

Schedule Your Inspection

Please Select a time frame for your selected date:
8:00am - 10:00am 9:00am - 11:00am 10:00am - 12:00pm 11:00am - 1:00pm
12:00pm - 2:00pm 1:00pm - 3:00pm 2:00pm - 4:00pm 3:00pm - 5:00pm

Payment Information

Please select your method of payment:
At Time of Inspection Bill me at Settlement Pay Now!

If making your payment now, please complete the following:
Credit Card #: Security Pin: Expiration Date:

Terms of Agreement
• To inform the selling agent of the date and time of the inspection when lockbox access is granted. • That the inspection will be cancelled in the event that any inaccurate information cannot be confirmed prior to the inspection date by Holiday Termite & Pest Control. • In the event settlement is postponed or cancelled, inspection fees are due within two weeks of the original settlement date unless agreed upon in writing by an authorized Holiday Termite & Pest Control representative. • It is the USER's responsibility to confirm that all paperwork has been delivered to settlement within 48 hours of the settlement date. • To inform Holiday Termite & Pest Control immediately of any changes in the information provided. I Agree