• VANTREX Client Intake & Hazard Screening

    Please complete this form to initiate services and ensure safety compliance for your property.

  • Client Information

  • Format: (000) 000-0000.

  • Property Information

  • Is the property occupied?*

  • Services Requested

  • Services Requested*

  • Property Condition Overview

  • Are utilities on for Electric?*
  • Are utilities on for Water?*
  • Are utilities on for Gas?*

  • Hazard Screening

  • Have you observed mold inside the property?*
  • Are there areas with moisture, leaks, or strong odors?*
  • Is this urgent?*
  • Are there unsafe floors, ceilings, or stairs?*
  • Any signs of collapse or severe structural damage?*
  • Are there signs of rodents, insects, or wildlife?*
  • Are there chemicals, strong odors, or unknown substances present?*
  • Has anyone been living in the property without permission?*
  • Are there any weapons or illegal items on site?*

  • Photos

  • Upload a File
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  • Are there any biohazards present?*
  • Do you need a quote before scheduling?*

  • Digital Signature

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Scheduling

  • Preferred Service Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Preferred Time Window

  • Final Confirmation

  • Should be Empty: