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Termite Report Request (BLB Resources, Inc.)

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4D - Revised 8-7-20
4D: IA, NE, SD, WI
Termite Report Request
Please note: Termite inspections are ordered automatically on all properties where the buyer is obtaining
FHA financing. If you would like a copy of this report, please complete this form and submit via fax to
949-379-2895 or email to 4Dinspections@blbresources.com.
Date: __________________
Property Information
FHA Case Number: __________________________
Property Address (include city, state & county):
__________________________________________________________________________________
Purchaser (s): ___________________________ ___________________________________________
Selling Broker Information
Brokerage Company Name: ___________________________________________________________
Office Phone Number: ____________________ Fax Number: __________________
Selling Agent’s Name: _______________________________________________________________
Cell Phone Number: _______________
Email: ____________________________________________________________________________
_____________________________________________________ __________________
Purchaser Signature (Required) Date
_____________________________________________________ __________________
Purchaser Signature (Required) Date
______________________________________________________ __________________
Selling Agent Signature (Required) Date
This section for BLB Resources, Inc. use only
Date Termite Report Sent: _________________________
Method: Email US Mail Fax
Sent by:_______________________________________________
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Completed 9 February 2021

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