Order Form

Project Address

City or County

Lot/Block/Subdivision

or Parcel ID

Gate Code

Client Name *

First

Last

Phone

Email *

Ordered by

Email *

Due Date

Title Company

Point of Contact

Email *

Responsible party for payment *

Responsible party phone number

Email *

Billing Address *

Description of Service

Quoted Cost $

Note: Rain and natural causes may delay the completion of the survey. *Cancellations must be provided in writing via email before job is in field/completed. If a job is in the field or completed, billing party is responsible for payment. *Person signing orders is responsible for paying for survey if property does not close. A 1.5% monthly late fee will be applied to all unpaid invoices after 30 days.

Responsible Party Signature:

*By signing I authorize Voelker Surveying to proceed.

Ronald J. Voelker, Jr. Professional Surveyor