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NATURAL HAZARD   DISCLOSURE   REPORT   (Issued by Buyers Real Estate Service)
Assessors Parcel Number
County
Seller Name



Return Via:

Priority Mail    Fax    
Email
Deliver To:
Seller's Agent         Escrow
Buyer Name
Property Address
City  State      Zip 
Submitted by Agent
Submitted by Coordinator
Real Estate Firm     
Agents Name        Phone Number
Address              
Coop Agent Company
Cooperating Agent  Phone Number
Address                   
If you provide us with your E-Mail Address and a 4 to 6 character Password you can use Click-To-Cover on-line ordering and receive instant confirmation of your orders.
Email Address    Password
Submitted by Closing Agent
Closing Company
Closing Officer   Phone   
File Number   Expected Close Date 
Address
City   State    Zip
Coverage:
OPTIONS
  $60 Air Conditioning System
  $50 Green Option
  $135 Pool/Spa Equipment
  $75 Additional Pool/Spa
  $50 Kitchen Refrigerator w/IceMaker & Dispenser
  $25 Wet Bar Refrigerator
  $25 Wine Bar Refrigerator
  $75 Washer/Dryer
  $105 Washer/Dryer Refrigerator
  $30 Septic system/Sewage Ejector Pump
  $30 Septic Tank Pumping
  $100 Roof Coverage
  $120 Well Pump System
  $100 Extended Pipe Leak
  $20 Red Tag Option sm
  $100 Relocation/Alteration Option
TOTAL 
For price quote for DUPLICATE SYSTEMS(on homes over 5000 sq.ft.) Please call (800)443-5599.
If you provide us with your E-Mail Address and a 4 to 6 character Password you can use Click-To-Cover on-line ordering and receive instant confirmation of your orders.
Email Address    Password
Comments: