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50%
Product
REALTOR 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
*
Hidden
Property Address
When would you like to conduct the testing?
1ST Preference of date of test
MM slash DD slash YYYY
Time
:
Hours
Minutes
AM
PM
AM/PM
2nd Preference of date of test
MM slash DD slash YYYY
Time
:
Hours
Minutes
AM
PM
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) - $350.00
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
Describe
Sub Total :
$0.00
Total :
$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 CLIENTS
6 MONTHS FREE
Buyer Name(s):
*
Property Address:
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Est Date of Settlement:
*
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.
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