Inspection Request Form
Printable Version

   Client Information

   Name_________________________________________

   Address _____________________________________

   City _____________________________________

   State, Zip  _____________    _____________

   Home Phone _________________________

   Work Phone _________________________

   Cell Phone _________________________

   Fax: ___________________________

   Email _________________________________

 

 

   To be Inspected

   Address _____________________________________

   City _____________________________________

   State, Zip  _____________    _____________

 

 

   Agent Information

   Agent Name_____________________________________

   Agent Code_____________________________________

   Agent Address_____________________________________

   Company_____________________________________

   Phone___________________________________________

   Email_____________________________________

   Fax_____________________________________

   Cell Phone_____________________________________

   City, State, Zip_____________________________________

   Heated Square Footage_____________________________________

   Total Square Footage_____________________________________

   Deadline Inspection Date__________________________________________

   Inspection Time_____________________________________

   Age of Home_________

 

 

   Type of Structure:
   Please check    

 

  Beach house on piling/ open underneath

  Beach house on piling/1/3 storage under

  Beach house on piling/ full garage/storage

  Condo

  Ranch style home/ slab

  Ranch style home/ crawlspace

  Single wide home

  Single wide home with bedroom addition

  Double wide home

  Town Home / slab

  Town Home / crawlspace

  Duplex / both sides

  Duplex / one side

   Condo

   Patio Home/slab

   Patio Home/crawlspace

   Commercial Office

   Commercial Building/ Slab

   Commercial Building/ Crawlspace

   Other:

 

   Other to be inspected:
   Please check

   Detached building

   Detached one car garage

   Detached two car garage

   Detached three car garage

   Attached one car garage

   Attached two car garage

   Attached three car garage

   Swimming Pool Decking or Patio

   Swimming Pool & Decking / Patio

   Combination of the above/ please contact

 

   Method of payment:
   Please check          

 

  Check to be mailed with order

  Check on day of inspection

  By check or credit card net 10 days from

  By Visa

  By Master Card

  By Discover

  Cash

  On Closing date (understanding additional $40 closing fee)  

  Other:     

 

 

 

   Other services:
   Please check           

 

  Mold / air testing

  Dust / allergy testing

  Stucco Screening

  Radon Screening

  Water test–Bacteria, Total Coliform–E coli

  Water test-Chemical/Bacteria, Coliform - E coli - Lead-Nitrate - PH-Iron

  Water test-Complete Test, all above + Alkalinity – Chlorine- Copper Chlorine-Clarity-Hardness

  Other: