Radon-Ease ARMS Protection Plan Application

Radon-Ease ARMS Protection Plan Application

Address of Protected Property
Required items are marked with an asterisk*

*	Street:
*	City:
*	State:
*	Zip:
*	1) Has home ever been tested for radon?	Yes No
	2) Style of home?	Ranch Contemporary Colonial Split Foyer Other
	3) Age of home:
	4) Number of stories:
	5) Foundation type:	Crawl Space Basement* Slab Other
	*If basement, is floor a floating slab?	Yes No
	6) Is there an attached garage?	Yes No
	Are there any rooms above the garage?	Yes No
	7) Are there any sump pits/pumps?	Yes No
*	8) Is there an active radon system already in the home?	Yes No
*	9) Is there a passive or roughed in radon system already in the home?	Yes No
	10) Is the home vacant?	Yes No*
	*If not, do we have permission to enter the home?	Yes No
	11) Who should we contact for access to the home?
	Name:
	Phone:
	Confirmation number: (office use only)

Seller Information

	Name:
	Phone number:
	Real estate company:
	Agent:
	Listing expiration date:
	Agent phone number:
	Agent page/cell number:
	Agent fax number:
	Agent email:

Buyer Information
Required items are marked with an asterisk*

*	Name:
*	Phone number:
*	Email address:
*	Mailing address: (if different from property address)
*	City:
*	State:
*	Zip:
	Real estate company:
	Agent phone number:
	Agent page/cell number:
	Agent fax number:
	Agent email:

Closing Information

	Closing company name:
	Phone number:
	Closing date:
	Address:
	City:
	State:
	Zip:

The above named real estate company, in addition to representing the seller and/or buyer, acts as agent for Radon-Ease, Inc. in connection with the sale of this radon protection plan. The plan fee is to be paid at closing or at another agreed upon date.

Signature of Application: (typing your name implicates your signature)
Date: