WDIR Termite Inspection for Sale of Property Request Form

Agent #1 Name *

Agency/Company

Phone

Fax

Represent *

Buyer

Seller

Agent #2 Name *

Agency/Company

Phone

Fax

Represent *

Buyer

Seller

Property Information

Street Address *

Address Line 2

City *

Currently Occupied?

Yes

State *

Zip Code *

How will we gain access?

Lockbox on Property

Yes

Lockbox Code

CBS Code

Square Footage

Age of Structure (approximately)

Type of Structure

Other Information

Seller Name

Phone

Buyer Name

Phone

Title Company

Title Company Address

Street Address

Address Line 2

City

State

ZIP Code

Title Company Contact

Title Company Phone

Requested Date

Month

Day

Year

10 Day Inspection Period Ends

Month

Day

Year

Closing Date

Month

Day

Year

Comments

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WDIR Termite Inspection for Sale of Property Request Form

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Main Office

Accounting Office

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Mailing Address