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Please fill in the Information Below
Name:
Company:
Home Address:
Home Address:
Home City:
Inspection City:
Home State/Zip Code:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Inspection State/Zip Code:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Home #:
Work #:
Cell #:
Other #:
Fax #:
E-mail:
Is this the first home you are Purchasing?
Yes
No
Type of Inspection Below:
Sellers Inspection
Buyers Inspection
Home Review
Check Up
Radon Inspection
Title Company Inspection
Home Energy Audit
Multifamily - Select # of Units Below
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Commercial
Occupied:
Yes
No
Lock box:
Yes
No
Lock box #:
Style of house: Ranch / Colonial / 2 Story / etc:
# of Bedrooms:
Pick One
1
2
3
4
5
6
More than 6
# of Bathrooms:
Pick One
1
1.5
2
2.5
3
More than 6
Furnace type:
Gas Forced Air
Boiler
Oil Heat Forced Air
Hydronic Heat
Other
Roof age:
Home Sq/Ft:
Basement:
Full
Partial
Finished
Garage:
Attached
Detached
Number of Cars:
1
1.5
2
2.5
3
3.5
4
Your Requested
Date
of Inspection:
#1:
Day of Week
Sunday
Monday
Tuesday
Wednesday
Thrursday
Friday
Saturday
Month
January
February
March
April
May
June
July
August
September
October
November
December
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2nd
3rd
4th
5th
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23th
24th
25th
26th
27th
28th
29th
30th
31th
Year
2007
2008
2009
2010
2011
2012
2013
2014
2015
#2:
Day of Week
Sunday
Monday
Tuesday
Wednesday
Thrursday
Friday
Saturday
Month
January
February
March
April
May
June
July
August
September
October
November
December
1st
2nd
3rd
4th
5th
6th
7th
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25th
26th
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28th
29th
30th
31th
Year
2007
2008
2009
2010
2011
2012
2013
2014
2015
#3:
Day of Week
Sunday
Monday
Tuesday
Wednesday
Thrursday
Friday
Saturday
Month
January
February
March
April
May
June
July
August
September
October
November
December
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
13th
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17th
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19th
20th
21th
22th
23th
24th
25th
26th
27th
28th
29th
30th
31th
Year
2007
2008
2009
2010
2011
2012
2013
2014
2015
Best Times of Day:
#1:
#2:
#3:
Do you have a condition report? If yes, please fax a copy to 262-363-0994
Do you have any concerns you feel need to be addressed?
You are required at this inspection.