Geodetic Survey Services, Inc.

(All certifications must be completed at time of work being ordered.)

GSS Job#

Date:

Subdivision:

Lot:

Block Unit or Tax ID

Street Address:

Type of Survey:

Boundary Mortgage Elev. Certificate
Re-certification Other

Residential or Commercial

Loan Type:

Conventional FHA VA

Ordered By:

Name:
Company Name:
Address:
Email:
Phone:
Fax:

Signature:

Additional Comments or Certifications: (Buyer, Title Co., Bank, etc.)

Upon receipt of this order form, Geodetic Survey Services, Inc., is authorized to perform the work on the subject property, outlined above, under current price schedule. If you would like this survey sent to anyone other than the ordering company, please indicate with contact person, email address, phone, address and fax number where it should be sent.