Request for Mold Investigation

Client Contact Name Company Billing Address City/State/Zip Phone Number Cell Number Email Address Site Contact Person, if other than above Contact Phone Number Contact Email Adress

Address of Building to be Inspected Approximate Square Footer of the Structure Approximate Age of the Structure Pier & Beam Foundation?

Yes No

Two Story?

Yes No

Please describe your area(s) of concern/possible mold issue

Note: Upon receipt of the above information, ERI will provide a formal written proposal. Our proposal will outline all costs associated with the mold assessment, and will include field work, report preparation, sample analysis costs, and travel expenses (if necessary). Upon receiving your signed acceptance of our proposal, we will schedule the assessment at your convenience.

Submitted By Date

Request for Quote for Mold Investigation

Tyler Office

Fort Worth Office