TEOC Home Inspection Form
Buyers Information
Name:
Address 1:
Address 2:
City:
State:
Zip Code:
E-mail Address:
Phone:
Cell Phone

House Information
Year Build:
Stories:
Square Footage
Garage: (Yes or No)	- Select One - Yes No
Basic Home Inspection
Heat: (Yes or No)
	Gas	- Select One - Yes No
	Electric	- Select One - Yes No
Water Heater: (Yes or No)
	Gas	- Select One - Yes No
	Electric	- Select One - Yes No
	Other (State Type)
Water: (Yes or No)
	City	- Select One - Yes No
	Well	- Select One - Yes No
	Depth of Well

Additional Testing Requested
Radon Test: (Yes or No)	- Select One - Yes No
Lead Paint: (Yes or No)	- Select One - Yes No
Drinking Water Coliforms: (Yes or No)	- Select One - Yes No
Automated Partial Chemistry: (Yes or No)	- Select One - Yes No
Lead and Arsnic: (Yes or No)	- Select One - Yes No
Organic Solvents Screen: (Yes or No)	- Select One - Yes No
Any Other Comments:
Payment is required at time of service by cash. Payment my be made by credit cart via PayPal. An email link to PayPal will be sent if requested.
Please print a copy of this request for your records. Click the print button befor you click the submit button.
Please Email PayPal Link: (Yes or No)	- Select One - Yes No