Termite Inspection Report (TIR) Request Payment InformationBill To*EscrowBuyerSellerRequest Submitter / Responsible Party InformationName*Address* Street Address City ZIP Code Phone*Email* IMPORTANTIF ESCROW DOES NOT PAY FOR THIS INSPECTION WITHIN 30 DAYS OF COMPLETION, THE RESPONSIBLE PARTY (THE PARTY WHOSE BILLING INFORMATION IS LISTED ABOVE) WILL BE INVOICED. THE RESPONSIBLE PARTY MUST INITIAL BELOW TO ACKNOWLEDGE UNDERSTANDING AND ACCEPTANCE OF THIS REQUIREMENT. NO INSPECTION WILL BE SCHEDULED WITHOUT THE COMPLETION OF THIS SECTION. My initials below indicate: 1) that I understand and accept the billing constraints outlined above; and 2) that I agree to be held responsible for payment in the event that payment is not received from escrow.Inspection RequestRequested Inspection Date Requested Inspection Time : HH MM AM PM 2nd Choice Inspection Date 2nd Choice Inspection Time : HH MM AM PM Requested Inspector (optional)Property InformationProperty TypeHouseTownhouseCondominiumCommercial PropertyIndustrial PropertyProperty Square FootageClosing Date Address Street Address City ZIP Code AreaCondo Name (if applicable)Parking Stall # (if applicable)Contact PersonLockbox LocationLockbox ComboIs the property vacant?YesNoTenant Name (if applicable)Tenant Phone # (if applicable)Last Treatment Date Type of TreatmentTreatment CompanyAgent InformationBuyer's / Seller's AgentBuyer'sSeller'sThird ChoiceAgent NameCompanyBranch Address Street Address City ZIP Code Agent Office PhoneFaxCellularAgent Email Escrow InformationEscrow CompanyAddress Street Address City ZIP Code Escrow OfficerPhoneFaxEmail Property Escrow #Buyer's Last NameSeller's Last NameEmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.