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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:
QTY OPTIONS
  $20 CRES Plan
  $60 Air Conditioning / Evaporative Cooler
  $125 Pool/Spa Equipment
  $50 Additional Pool/Spa
  $50 Kitchen Refrigerator
  $50 Washer/Dryer
  $100 Roof Coverage
  $120 Well Pump
  $50 MAXIMUM UPGRADE Option
  $20 Red Tag Option sm
  $200 Structural Endorsement  (REQUIRES CHECKLIST COMPLETED AND SIGNED BY AN APPROVED INSPECTOR)
10/30 OPTION  Add 10% to the Total Coverage and reduce $55 Trade Call Fee to $30.
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
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