GeoDisclosure Order Form

Realty Company:
Realty Agent:

Property Information:

	Property Address:	, ,
	APN:
	Sellers name:

Type of report (check one)

GeoDisclosure - Natural Hazard Disclosure report
(includes Mello-Roos and special tax information) - $70

GeoEnvironmental Report - GeoDisclosure plus Environmental Contamination Report - $115

Environmental Report - $45

Where would you like the report sent?

How many reports should be sent to the following address? (up to 4)

	Company:
	Attn:
	Address:	, ,

And how many to this address?

	Company:
	Attn:
	Address:	, ,

Billing Information

	Escrow #:
	Title Company:
	City:
	Escrow Officer:
	Anticipated Closing Date:
	Additional Notes