Healthy Homes Home Inspection and Educational Services, LLC

1056 Bonnie Lane

Breaux Bridge, LA.

70517 (337)258-9411

(337)442-1170

FAX (337)442-1171

Please fill out the form below and send with a down payment of $500* to the address above five days prior to the beginning of the class.

Total cost of class is $1500.00

Registration for

First Name_________________________

Last Name_________________________

Company__________________________

Address 1_________________________

Address 2_________________________

City______________________________

State_____________________________

Zip_______________________________

Phone Number _____________________

Fax Number _______________________

Email Address______________________

How did you hear about Healthy Homes Home Inspection and Educational Services?_________________________________________________

*Balance of $1000.00 is due the first day of class.

*The textbook will be sent when the down payment is received.