Enter Your User I.D.
*
Inspector's License #
DATE OF INSPECTION
*
-
Month
-
Day
Year
Date
Square Feet of Home Range (Change if Needed)
Please Select
0-1000
1000-2000
2000-3000
3000-4000
4000+
EVIDENCE OF TERMITES OR WDI'S FOUND?
*
Please Select
NO - PREVENTATIVE PROPOSAL ONLY
YES - CORRECTIVE PROPOSAL
SUPPLEMENTAL (CLEARED OF TERMITES)
NO QUOTE OR TREATMENT REQUIRED
PRE-TREATMENT
OTHER
Termite or Other WDI Evidence Observed
Please Select
Sub Termite Tube(s)
Sub Termite Stains
Sub Termite Tube(s) & Stains
Sub Termite Kickhole(s)
Sub Termite Kickhole(s) & Stains
Sub Termite Tube(s), Kickhole(s) and Stains
Sub Termite Damage
Sub Termite Damage & Stains
Sub Termite Damage, Stains and Tubes
Drywood Termites
Drywood & Sub Termites
Carpenter Bees
Sub Termite & Carpenter Bees
Carpenter Ants
Type of Wood-Destroying Insect
SU - Sub Termite
DR - Drywood Termite
CA - Carpenter Ants
DA - Dampwood Termites
BE - Beetles
Other
Treatment Cost (Leave as Default or Change Manually if Needed)
Proposed Treatment Methods or Other Services
Trench and/or Rod (Full Perimeter)
Treat Active Areas
Treat Expansion Joint (As Possible)
Foam Application
Area Treatment
Spot Treatment
Treat Cracks & Crevices
Saok Pavers
Mobile Home Treatment
Treat Crawl Space
Post Tension
Stem Drill Structure
Down Drill
Termite Bait Stations
Rodent Trapping & Monitoring ($499)
Rodent Bio-Cleanup ($499)
Rodent Exclusion ($299)
Pest Control Spray for BINSR only ($199)
Pack Rat Service ($499)
Request Discount (Non-Termite Only)
Other
5B. ADDRESS (Street, City, Zip)
*
Contact Name (Realtor)
Contact E-Mail (Realtor)
Contact Phone # (Realtor)
1B. REPORT TYPE
*
ORIGINAL REPORT
SUPPLEMENTAL REPORT
1C. Inspection Type
*
SALE
REFINANCE
OTHER
PROPERTY STATUS
*
VACANT
OCCUPIED
UNFURNISHED
FURNISHED
6A. Inspected Structures
7. THE FOLLOWING AREAS ARE OBSTRUCTED OR INACCESSIBLE
EVIDENCE OF PREVIOUS TREATMENT?
NO
YES
Evidence of Previous Treatment (Select One)
Please Select
N/A
Drill Holes
Drill Holes (Not Documented on AZDA Website)
Drill Holes & Documented on AZDA Website
AZDA Website Treatment History
Termite Bait Stations
Previous Treatment Target Pest (Optional)
Please Select
N/A
Subterranean Termites
Dry-wood Termites
Carpenter Ants
Carpenter Bees
Other
9. DAMAGE OBSERVED?
NO
YES
Visible Damage Due To
Damage Observed In The Following Areas
15. (EC) - Wood to Earth Contact
NO
YES
EC - Type(s)
Pier Posts
Porch Posts
Plants/Trees Contacting Structure
Porch Stairs
Concrete Form Boards
Fence Abutting Structure
Trellis
Other / Comments
(CD) - EXCESSIVE CELLULOSE DEBRIS
NO
YES (Comment as Needed)
(FG) - Faulty Grade
NO
YES
(FG) - Type(s)
Stucco at or Below Grad
Wood Siding Below Grade
Evidence of Surface Water Draining Towards House
Floor Level Planters at Or Below Grade
Joists in Crawls Space Less Than 24" Above Grade
Other
(EM) - EXCESSIVE MOISTURE
NO
YES
EM - Type(s)
Water Stain
Water Damage
Bath/Shower/Toilet Leaking
Plumbing Leaks
Attic/Roof Leak
Standing Water
Sprinklers Hitting Structure
Crawls Space/Water Leaking
Inadequate Ventilation
Improper Condensate Drainage
Other
(IA) - INACCESSIBLE AREAS
NO
YES
IA - Type(s)
Plumbing Traps
Attic - Partial
Attic - All
Attic - Joists
Floors
Wall Interiors
Enclosed Stairwell
Dropped Ceilings
Sub/Crawl Space Area - Clearance
Sub Area / Crawls Space No Access
Areas Obstructed By Furniture Or Stored Articles
Other
(FI) - Areas Where Further Inspection Needed?
NO
YES (Note Detail)
Pest Control Inspector's Additional Comments
Signature of Inspector
*
Picture of Home
Graph Photo - (As Needed)
Evidence Image 01 (Optional)
Evidence Image 02 - (Optional)
Evidence Image 03 - (Optional)
Want to add more pictures? (Select How Many)
Please Select
Add 6
Evidence Image 04 - (Optional)
Evidence Image 05 - (Optional)
Evidence Image 06 - Optional
Evidence Image 07 - Optional
Evidence Image 08 - Optional
Evidence Image 09 - Optional
Preview PDF
Save
Submit
Warranty Length
Please Select
N/A
6 Months
15 Months
18 Months
1 Year
2 Years
3 Years
5 Years
2 Years / 5 Years
1 Year (Area Only)
Target / Covered Pest
Treatment Type
Please Select
N/A
Prothor SC2
Taurus SC
Termidor HE
Fuse Foam
Termidor Foam
Taurus SC & Prothor SC2
Trelona ATBS Bait Stations (Termite)
Active Ingredient
Please Select
N/A
Imidacloprid
Fipronil
Fipronil & Imidacloprid
See Next Page
Novaluron 0.5%
$(Placeholder)
TARF # (Optional)
Telephone Number
*
NAME OF INSPECTION COMPANY
*
ADDRESS OF INSPECTION COMPANY
*
Business License #
*
Inspectoremail
example@example.com
8. Visible Evidence Of Wood-Destroying Insects Observed?
*
NO
YES
Damage (Actions)
Will Be Or Has Been Corrected By This Company
Will Not Be Corrected By This Company
We Recommend Damage Be Evaluated By Structural Contractor
NAME OF OWNER / SELLER
Job Status
Please Select
N/A
WON
LOST
IN PROGRESS
HOT
WARM
DEAD
PARKED
Should be Empty: