Termite Inspection Report (TIR) Request Page

Payment Information
Bill To
Request Submitter / Responsible Party Information
Name*
Address*
Street Address City ZIP Code
TMK Number

Tax Map Key Number
Phone*
Email*
IMPORTANT
IF ESCROW DOES NOT PAY FOR THIS INSPECTION WITHIN 30 DAYS OF COMPLETION, THE RESPONSIBLE PARTY (THE PARTY WHOSE BILLING INFORMATION IS LISTED ABOVE) WILL BE INVOICED. THE RESPONSIBLE PARTY MUST INITIAL BELOW TO ACKNOWLEDGE UNDERSTANDING AND ACCEPTANCE OF THIS REQUIREMENT. NO INSPECTION WILL BE SCHEDULED WITHOUT THE COMPLETION OF THIS SECTION.

My initials below indicate: 1) that I understand and accept the billing constraints outlined above; and 2) that I agree to be held responsible for payment in the event that payment is not received from escrow.
Inspection Request
Requested Inspection Date
MM slash DD slash YYYY
Requested Inspection Time

: Hours

Minutes

AM/PM
2nd Choice Inspection Date
MM slash DD slash YYYY
2nd Choice Inspection Time

: Hours

Minutes

AM/PM
Requested Inspector (optional)
Property Information
Property Type
Property Square Footage
Closing Date
MM slash DD slash YYYY
Address
Street Address City ZIP Code
Area
Condo Name (if applicable)
Parking Stall # (if applicable)
Contact Person
Lockbox Location
Lockbox Combo
Is the property vacant?
Tenant Name (if applicable)
Tenant Phone # (if applicable)
Last Treatment Date
MM slash DD slash YYYY
Type of Treatment
Treatment Company
Agent Information
Buyer's / Seller's Agent
Agent Name
Company
Branch Address
Street Address City ZIP Code
Agent Office Phone
Fax
Cellular
Agent Email
Escrow Information
Escrow Company
Address
Street Address City ZIP Code
Escrow Officer
Phone
Fax
Email
Property Escrow #
Buyer's Last Name
Seller's Last Name
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Termite Inspection Report (TIR) Request

Payment Information

Request Submitter / Responsible Party Information

Inspection Request

Property Information

Agent Information

Escrow Information