PROJECT MOLD - Application Form
In order to be eligible you must:

* Have a permanent address.
* Have been exposed to water damage. All leaks (walls/roof) must be sealed.

Terms and Conditions:

* Maximum 1 application per house
* E-mail photo's of house with evidence of mold to:
* The applicant of this form must be present during the assessment
* Failing to show up or comply with given time slots or agreements will automatically terminate this application.
* All fields below must be answered

We will contact each individual for a date and time slot for an assessment once the applicant meets all requirements.

Email address *
First Name *
Your answer
Last Name *
Your answer
Date Of Birth *
House Address *
Your answer
District *
Your answer
Phone Number *
Your answer
Do you have children? *
Do you have a disability? (e.g. health problems, walking difficulties) *
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