Step 1 of 2 50% ProductREALTOR CONVENIENCE FORM - ORDER YOUR TESTING AND FREE WELGARD Let’s get started ! ( It only takes 2 minutes ! )Realtor's Name*Realtor's Telephone #*Realtor's E-mail Address* Property AddressWhen would you like to conduct the testing?1ST Preference of date of test Date Format: MM slash DD slash YYYY Time : HH MM AM PM 2nd Preference of date of test Date Format: MM slash DD slash YYYY Time : HH MM AM PM What Services do you need? Yield Test (minimum 3 hour; required in Baltimore County) - $475.00 Modified Yield Test (approx. 90 – 120 minutes; qualifies for WelGard® Protection) - $325.00 Standard potability (includes coliform and e-coli bacteria, pH, Nitrates, Sand and Turbidity) - $150.00 Optional Lead Testing (required for VA/FHA) $55.00 Other - $0.00 DescribeSub Total :$0.00Total : $0.00 You will receive e-mail confirmation of your selections within 24 hours of submission!! COMPLETE THE FOLLOWING TO GET WELGARD® PROTECTION FOR YOUR CLIENTS6 MONTHS FREEBuyer Name(s):*Property Address:* Street Address City State / Province / Region ZIP / Postal Code Est Date of Settlement:* Date Format: MM slash DD slash YYYY E-Mail address of Buyer:* Phone #:*Any known problems with the well? Yes No If WelGard® is not completing the testing, check here and remit any testing to [email protected] Please review your order and click "Submit" once to complete. {all_fields}
