Country Home Inspection & TERMITE, Inc.
250 Main Street #805, Ben Lomond, CA 95005
PH: (831) 609-6017  Fax: (831) 609 - 6037
Clive Belvoir
(831) 609-6017

Payments can be paid at the time of service or you can fax or mail your
payment into our office.

(Please print out this form and mail in your payment to the below address)

Checks or money orders can be sent to the following address
payable to "Country Home Inspection & Termite, Inc.":

Clive Belvoir
Country Home Inspection & Termite, Inc.
250 Main Street #805
Ben Lomond, CA  95005

Credit Card Payments:

For your convenience, we accept all major credit cards
(You can call in your credit card information @ 831-609-6017 or
print out this form and fax to 831-609-6037).

Name on Card: _________________________________________________

Credit Card Number: _____________________________________________

Check one:  ___Visa  ___Master Card  ___American Express  ____Discover

Expiration Date: _____________________________

Signature: _________________________________