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RICHMOND OFFICE

Parker Design Group, Inc.
1915-B W. Cary Street
Richmond, Virginia 23220
Phone: 804.358.2947

ROANOKE OFFICE

Parker Design Group, Inc.
2122 Carolina Avenue, SW
Roanoke, Virginia 24014
Phone: 540.387.1153
FAX: 540.389.5767

Rocky Mount Office

Parker Design Group, Inc.
180 AMT Tech Drive, Suite 101-B
Rocky Mount, Virginia 24157
Phone: 540.483.0078

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Residential Order Form

Date needed

Date ordered

date of closing

Client Billing

ordered by

phone

company name

Address

E-mail

Fax

Project, Property, Information

Property Address

county

subdivision

Tax/parcel ID #

lot & Block

Service needed (check one)

Corner/Line Marking (no map)Bundary Survey (map)Elevation Certificate Building Permit Plot Plan

certify to

title company

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Richmond Office

Parker Design Group, Inc.
1915-B W. Cary Street
Richmond, Virginia 23220
Phone: 804.358.2947

Roanoke Office

Parker Design Group, Inc.
2122 Carolina Avenue, SW
Roanoke, Virginia 24014
Phone: 540.387.1153
FAX: 540.389.5767

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