Request for real estate water test
Please copy, paste and fill out the below agreement and email or fax it to us.
I ______________________________, on this _____ day of_____________, 2011, do
hereby request that Florida Environmental Laboratories, Inc. perform the following water
testing services:
FHA/USDA/VA water tests (Lead, Nitrate, Nitrite, Total Coliform bacteria, E. coli bacteria), for the property located at:
__________________________________(street address)
__________________________________(city, state, zip code)
By requesting these services I agree to ensure that payment of $249.00 ($349.00 minus a $100.00 discount for timely payment) is made within 30 days of completion of services and I further agree to accept liability for payment of these services and any late fees, legal fees, or collection fees on past due accounts unless prior written amendments are made by both parties to extend the timely payment period.
All testing will be done by approved methods and in compliance with Florida Department of Health requirements.
By filling out and electronically signing this form you are agreeing to abide by this agreement and to pay for services in a timely matter.
email to: floridalabs@yahoo.com
fax to: 800.939.2308