Mail to: Home Inspector Yellow pages

 Merrell Institute

 P.O. Box 5472, Hauppauge, NY 11788

PRINT THIS FORM

MAIL THIS FORM IN WITH PROPER PAYMENT

NAME__________________________________________________________________________________

COMPANY NAME_______________________________________________________________________

STREET ADDRESS_______________________________________________________________________

TOWN, STATE AND ZIP CODE ____________________________________________________________

TELEPHONE NUMBER INCL. AREA CODE__________________________________________________

FAX NUMBER INCL.  AREA CODE_________________________________________________________

E-MAIL ADDRESS_______________________________________________________________________

WEB SITE ADDRESS_____________________________________________________________________

WHICH STATE DO YOU WISH TO BE LISTED IN? SELECT ONE!_______________________________

IF YOUR STATE HAS LICENSING, WHAT IS YOUR LICENSE #_________________________________

DOES YOUR STATE HAVE LICENSING?______ ARE YOU LICENSED?________ LIC #____________

Fee $ 195.00   FREE IF YOU ARE A NORTH AMERICAN ASSOCIATION NETWORK MEMBER

Signed_______________________________________________________ Dated_____________________

For an additional $ 49.00, do you want an enhanced listing? An enhanced listing allows you to give up to 100 letters and spaces after your listing explaining your services and you will be positioned at the top of each state link- again, the service is an additional $ 49.00- If you are already enrolled, the fee is simply $ 49.00.

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All information will be listed in the directory under the state specified- Allow 10 days from receipt including payment to be posted- you will receive an e-mail confirming your posting.

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