Warranty Registration                             X-Mold Home                            

User ID                                                                        Treated Areas:     

Product Type                                                     First Floor Complete Treatment:      Yes No

Application Date                                                First Floor Spot Treatment:              Yes No

 Builder                            Spot Treatment Comments:                               

 Subdivision                                                         Second Floor Complete Treatment:  Yes No   

 Lot #                                                                  Second Floor Spot Treatment:          Yes No                          

 Home Type                       Single Family Home Muti-Family Home Commerical                                   Spot Treatment Comments:                

 Address                                                             Basement Complete Treatment:       Yes No  

 City                                                                    Basement Spot Treatment:                Yes No                        

 State                                                                  Spot Treatment Comments:                                         

 Zip                                                                     Garage Complete Treatment:             Yes No                                                                                     

Application Specifics:                                                                             Garage Spot Treatment:                     Yes No  

Total Sq. Ft. Under Roof                                    Spot Treatment Comments:                                                                                                                                                

Gallons Used                                                       Bath & Kitchen Wet Areas:               Yes No                                                                                                  

Type of Treatment:                                                                                           

Prevention                 Yes No                                                                                                                                       

Remediation              Yes No                                                                                                                        

                                                                                                                         Additional Comments  

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