COMPLETE THE FOLLOWING TO GET WELGARD® PROTECTION FOR YOUR CLIENTS6 MONTHS FREERealtor InformationIf there is no realtor, insert ‘None’ in the name, email and telephone responses belowRealtor's Name* Realtor's Telephone #*Realtor's Email Address* Buyer InformationBuyer 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] Δ
