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Clearance Letter/Wood Destroying Organism Report Request Form

  • Agent #1 Name(Required)
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  • Agency/Company(Required)
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  • Email (Required)
  • Please enter email address.
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  • Phone (Required)
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  • Represent (Required)
    • Buyer
    • Seller
  • Person Responsible for Payment (Required)
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  • Agent #2 Name
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  • Agency/Company
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  • Email
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  • Represent
    • Buyer
    • Seller

  • Property Information

  • Address (Required)
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  • Please enter your city.
  • Please enter your state.
  • Please enter your zip code.
  • Currently Occupied?
    • Yes
    • No
  • Lockbox Code
  • This field is required.
  • Type of Structure
    • Basement Finished
    • Basement Unfinished
    • Slab
    • Crawl Space
    • Unknown

  • Additional Structures

  • Are there any additional structures besides the home itself needing inspection?
  • Please make a selection.

  • Other Information

  • Seller Name
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  • Seller Phone
  • Please enter phone number.
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  • Seller's Email Address
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  • Buyer Name
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  • This field is required.
  • Buyer Phone
  • Please enter phone number.
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  • Buyer's Email Address
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  • Closing Attorney
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  • Requested Date
  • Closing Date
  • Email address where report needs to be sent
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  • Comments
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  • Loan Type

  • Loan Type
    • Cash
    • VA
    • USDA
    • FHA
    • Conventional
    • Other
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