NC Residents - Complete the survey and enter your name and address
to receive a discounted radon testing kit.
What year was your home built?
Does your home have a...
(Check all that apply)		 Basement
Crawl Space
Slab Foundation
Don't Know
Type of water supplied to home? Private Well
Community Well
City/County Water
Don't Know
Are there children living in the home on a permanent basis? Yes
No
Have you tested your home for radon before? Yes
No
If yes, when?
Are there any Smokers in the home? Yes
No
Provide either an e-mail address or daytime telephone number.
E-Mail Address
Daytime Phone
Quantity of test kits to purchase? One for $5.34
Two for $10.68
( Total price after tax )
Mailing Information
Name:
Street:
City:
State:   Zip: