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PROPERTY   DISCLOSURE   REPORT   (Issued by Buyers Real Estate Service)
Assessors Number (APN#)
County
Seller Name
Buyer Name
Property Address
City  State      Zip 
Phone

Arizona Hazards Disclosure Report FREE if ordered with a home warranty.

Return Via:

Fax     Email
Deliver To:
Seller's Agent         Escrow
To Be Paid By:
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
  $150 Pool/Spa Equipment
  $50 Additional Pool/Spa
  $25 Kitchen Refrigerator
  $50 Washer/Dryer
  $100 Roof Coverage
  $120 Well Pump
  $40 PREFERRED UPGRADE 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
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