YOUR E-MAIL ADDRESS: *   REFERRED BY:

REQUESTED INSPECTION DATE: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2008 2009 2010 2011

CUSTOMER NAME: *
ADDRESS OF PROPERTY TO BE INSPECTED: *
CITY: *   STATE: *   ZIP:
HOME PHONE: *   WORK/CELL PHONE: *  FAX:

IS THIS HOUSE ON THE MARKET FOR SALE? YES    NO
REALTOR:    COMPANY:
OFFICE PHONE:    CELL PHONE:    FAX:

LISTING AGENT:
OFFICE PHONE:    CELL PHONE:    FAX:

MAILING ADDRESS FOR REPORT (if other than above)
NAME:
ADDRESS:
CITY:    STATE:    ZIP CODE:

WHAT KIND OF SIDING DOES THE HOME HAVE?*
STUCCO? YES    NO
IF "YES", NUMBER OF STUCCO WALLS: <choose one> 1 2 3 all   TYPE OF STUCCO: <choose one> EIFS synthetic Dryvit not sure
IF "NO", TYPE OF SIDING: <choose one> vinyl wood hardboard (Masonite) metal other

APPROXIMATE AGE OF HOME: <choose one> under 25 25 to 50 51 to 75 76 to 100 over 100 years
COLOR OF HOME:
NUMBER OF LEVELS: *

Please only answer one of the following two fields.*
1) IF ONLY ONE STUCCO WALL IS TO BE INSPECTED CHECK HERE:
2) IF MORE THAN ONE STUCCO WALL IS TO BE INSPECTED
     SELECT APPROXIMATE FINISHED SQUARE FEET: <choose one> up to 3,000 up to 4,000 up to 5,000 up to 6,000 up to 7,000 up to 8,000 sq. ft.
(If over 8,000 sq. ft. please specify below in Additional Comments and we will call you with an estimate.)

Your estimated inspection fee will be approximately
Cash, Check or Credit Card accepted at the time of inspection.

ADDITIONAL COMMENTS