Owners Name:       Property Address: 

City:      State:    Zip:     Property Township: 

Last Radon Result: pCi/L  -  Test Start Date:    Stop Date:   Tester: 

 Is the house a:  Two story: |  Bi-level: |  Ranch: |  Cape cod: | Contemporary: |  Split level:

How old is the house:       Can we contact Owner to schedule a visit?     Is house vacant?

Does house have a lockbox?     Can we knock 1st & use lockbox?   Settlement Date: 

   Can we have Owners Phone number in case we are late?    Owners Home Phone:

Owners Work Phone:        Which Owners work #?

Owners Cell Phone:       Which Owners cell #?

Selling Agent:      Selling Agent Real Estate agency:

Selling Agent work Ph #:     Fax #     Cell Ph #

Buyers Agent:       Buyer's Real Estate agency:

Buyers Agent work Ph #:     Fax #     Cell Ph #

Buyers Names:

Additional Comments:

Please fax the MLS and the Radon Test report to fax # 610 346-8575