*To avoid delay in the forwarding the Radon test report, print and fill out the information below on the day of the test request and forward to the Radon Testing Co. 1657 Red Oak Lane Rockford, Il. 61107 or copy and attach to: TomBrain1@aol.com
MUST HAVE INFORMATION:
Name, Print all.__________________________________________________________________________
Address, Tested: _______________________________________________________________
City & Zip:____________________________________________________________
Your Agent & Co._______________________________________________________________
*CREDIT CARD FORM: PRINT ALL
TYPE OF CARD: Visa _______ MC ______ Discover _________ American Ex ________
Card No. ___ ___ ___ ___/___ ___ ___ ___/___ ___ ___ ___/___ ___ ___ ___
Exp. Date___ ___/___ ___
Amount:___________
Address on Card: _____________________________________________________________________
City & Zip: ____________________________________________________________
*CHECK ENCLOSED _____ NO: ____________
Amount: ___________
Mail to: Radon Testing Co.
1657 Red Oak Lane
Rockford, Il. 61107
Phone: 815-397-2366
Fax: 815-394-1611
Thank you, For Testing your home for Radon; to ensure a Safe & Healthy home.
The Best of Health, Thomas Brain
