Property Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Seller Name *

First Name

Last Name

Seller Phone *

(###)

###

####

Billing Address *

Please provide a forwarding address for the responsible party other than the property address.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Alternate Phone

(optional)

(###)

###

####

Close of Escrow Date

Please keep us updated on any changes or postponements in the COE date.

MM

DD

YYYY

For Sale By Owner

Yes

No

Listing Agent Name

First Name

Last Name

Listing Agent Phone

(###)

###

####

Transaction Coordinator

First Name

Last Name

Transaction Coordinator Phone

(###)

###

####

End of Inspection Period Date

MM

DD

YYYY

Water source of the property

Please list in job notes if water will NOT be available for use during inspection. Please disregard if attaching MLS.

Private Well

Shared Well

Municipal

Private Water Company

Hauled Water

No Water

Other (please list in notes)

I understand that pumping of the septic tank(s) is an additional fee and is required by the state to complete the septic inspection. The homeowner must pay for septic pumping in addition to any fees owed to A&R Septic for the inspection. *

JT's Septic is A&R's preferred septic pumper. JT's Septic will have an additional invoice for pumping due separate from A&R's invoice. JT's can be reached at 928-632-7077 for additional information on costs and fees.

I understand and agree to pay the additional pumping fees as required.