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Service Order Form

Price Office Price

Landlord, Owner or Agent’s Name: *

Office #

Mobile # *

Email Address: *

Tenant Information

Tenant’s Name: *

Voucher #:

Address: *

Tel #: *

Request For Service

Please Select Your Desired Service By checking The Appropriate Box(es) Below

Service 1

Certification of Completed Repairs (Apt. Only) - $100.00

Service 1 Price

Service 2

Certification of Completed Bldg. Repairs (Public Space Only) - $100.00

Service 2 Price

Service 3

Owner Lead-Based Paint Certification - $100.00

Service 3 Price

Service 4

Certification of Completed Repairs (Apt. & Public Space) - $150.00

Service 4 Price

Service 5

Certification of Completed Repairs (Apt. & Lead-Based Paint) - $150.00

Service 5 Price

Service 6

Certification of Completed Repairs (Public Space & Lead-Based Paint) - $150.00

Service 6 Price

Service 7

Certification of Completed Repairs (Apt, Public Space & Lead Paint) Most Popular Selection - $225.00

Service 7 Price

Service 8

Re-inspection Certification - $50.00

Service 8 Price

Service 9

Special Inspection Certification - $50.00

Service 9 Price

Service 10

Change/Correction of Landlord’s information - $50.00

Service 10 Price

Sub Total:

Sales Tax

Sales Tax (8.875%): $0.00

Credit Card Fees

Credit Card Fee (3.75%): $0.00

Total

$0.00

Thank you for using The Certification Company! Please make the payment and consent form to complete the process.

Print Name:

Date:

Signature: *

Clear Signature

Consent to Sign

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Address

418 Broadway #4237
Albany, NY 12207

[email protected]

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