Global Prevention Services


ZIP/Postal Code (Location of Request):	*

Have you previously tested your home for mold?		Yes No

What are the reasons for wanting to remove the mold? (Select all that apply)		I Can See it I Can Smell it Buying a home Selling a home See evidence of dampness or other water intrusion in home Family member(s) suffer cold, allergy, or asthma symptoms Having new home constructed Just want to have home checked Other

What is the location of mold in your home? (Select all that apply)		Attic Ducts and/or heating & air system Exterior of home Windows Basement or crawl space Interior of home (walls, ceilings, carpeting, furnishings) Unexposed materials in my home (behind ceilings, walls, under floors, etc) Other Do not know

What is the approximate size of the visible contamination?		1-10 Square Feet 10-30 Square Feet 30-100 Square Feet Over 100 Square Feet

What materials are potentially affected? (Select all that apply)		Aluminum window frames Brick or Stone Carpet Clothing Concrete Draperies Flooring Insulation Siding Tile or grout Upholstery Wallboard or plaster Wood framing or plywood Wood trim Other Do not know

Do you know of a water intrusion or excessive moisture that could encourage the growth of mold? (Select all that apply)		A leak or broken pipe Moisture or condensation from inside the home Ground water from outside or under the house Do not know

Choose the appropriate status for this project:	*

When would you like this request to be completed?


Is this request covered by an insurance claim?		Yes No

Is this location a commercial location?		Yes No

Do you own the home for this request?		Yes No

Please provide a short description of your project:	*

First Name:	*
Last Name:	*
Address (Project Location):	*
City:	*
State:	*
ZIP/Postal:	*
E-mail:	*
Day Phone:	*
Cell Phone (Recommended):
Evening Phone:
Contact Time:	*