ProeX Termite Inquiry Form
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First Name
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Last Name
Date today
*
Your Phone#
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Are you selling your home?
yes
no
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Your E-mail address
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Address of Property (Street, Apartment, City, State, Zip)
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Your MAILING Address (Street, Apartment, City, State, Zip)
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Are you the owner of the property/home?
yes
no
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Are you the buyer of the property/home?
yes
no
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Have you had any other reports, inspections, estimates the last 2 years?
yes
no
n/a
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Has any termite related work been done the last 2 years?
yes
no
n/a
Realtor's Name
Realtor's Phone
Name of Escrow Company
Escrow Co. Phone/Fax
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Is the property occupied?
yes
no
Tenant Name
Tenant Phone
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How did you hear about us?
Google
Yahoo
Referred by family or friend
Phone book
Other
Any comment or question you may have.
*
Indicates Response Required
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