Client's First Name: Last Name: Buyer Seller Buyer's Agent Seller's Agent Owner Other

Client's Address:

City:     State:    Zip:

Client's E-mail:

Client's Phone: Home.... Work.... Cellular

Client's Second Phone: Work.... Cellular

Client's Agent: Realty Office:

Agent's Phone: Home.... Work.... Cellular

Agent's Second Phone: Work.... Cellular

Agent's E-mail :

NOTE: Please fill in all the information that you know. If you don't know some of the items please leave the selection blank.

Inspection Address:

City: Inspector Access: Method of Access Home has Realtor Keybox Buyer's Agent will open Seller's Agent will open Seller will open Buyer will open Home will be left open Neighbor will open

Type of Dwelling: Single Family Dwelling Single Family w/Inlaw Apartment Duplex Non-Conforming Duplex Condo

Year of Construction: or Approx. Decade: 1990's late 1980's early1980's late 1970's early 1970's late 1960's early 1960's 1950's 1940's 1930's 1920's 1910's 1900's 1890's 1880's 1870's Older than 1870

Square Footage: Select Total Size Up to 1100 Sq ft 1101-1400 1401-1800 1801-2300 2301-2700 2701-3100 3101-3600 3601-4300 4301-4900 4901-5700 5701-6500 Larger than 6500 Status: Occupied........ Vacant

Bedrooms: One Two Three Four Five Six Seven Eight Nine > Nine Bathrooms: One Two Three Four Five Six Seven Eight Nine > Nine

Space Underground: Basement...... Walkout Basement...... Crawl Space

Heating: Forced Air Heating Electric Heating Boiler heat Gravity Gas Heat Geothermal Other Forced Air Natural Gas Fireplaces: None One Two Three Four Five >Five Wood Stoves: None One Two Three Four Five > Five

Cooling: None....... Yes........ Type: Central A/C Window A/C Evaporative Cooler Window Evaporative None

Garages: Type One Car Two Cars Three Cars Four Cars None Carport Location: Attached Detached

Roof: Steep Pitched Average Pitch Low Pitch Flat Roof Roof Material: Composition Shingles Wood Shakes Tar/Gravel Metal Exotic Unsure

Wood Decks: None One Two Three Four More Than 4

Electricity: Power "ON" Power "OFF" Unknown

Water: Water "ON" Water "OFF" Unknown Type of Water Service: Public Private Well w/Pump Unknown

Fuel: Gas "ON" Gas "OFF" Propane "ON" Propane "OFF" No Fuel Source Unknown Type of Waste Service: Public Sewer Septic Unknown

HOME INSPECTION

Special Concerns & Comments:

We will contact you by telephone to schedule your Home Inspection within a few hours.

Thank you for your business.