First and Last Name:  * Email Address:  * Address:  * City:  * Zip Code:  * Day Phone Number:  * Cell Phone Number:   What are the reasons for wanting to remove the mold? (All that apply) Can see it Can smell it Buying pre-owned 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 ceiling carpeting furnishings) Unexposed materials in my home (behind ceilings walls under floors etc) Other   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 Carpet Concrete Flooring Siding Brick or Stone Clothing Draperies Insulation Tile or Grout Upholstery Wood framing or plywood Wallboard or plaster Wood Trim Other Don't Know   Do you know of any water intrusion or excessive moisture that cold encourage the growth of mold? (Select all that apply) A leak or broken pipe Ground water from outside or under the house Moisture or condensation from inside the home Don't know   *This request is for: Select OneMy own homeA subcontractor   *Choose the appropriate status for this project: Select oneReady to hirePlanning and Budgeting   *When would you like this project to be completed? Select OneLess than 1 week1-2 weeks3-4 weeks5-6 weeks   *Do you own the home for this request? Yes No   Please provide a short description of your project.   Do not enter anything in this field:

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