CUSTOMER INSPECTION REQUEST FORM

Customer Name
Customer Address
City, State, Zip
Phone Number
Email Address
Address of Property to be Inspected
Inspections Needed :

Structural (whole house)
Water (bacteria only)
Wood Destroying Insect
Radon
Water FHA
Water VA
Septic Pumping*
*If you desire pumping done as part of inspection check "Pumping" above. Note that additional fees apply.
Are you working with a realtor? Yes No
If yes, whom and at what agency?
If property is listed with an agency other than the one you are working with, please provide the Listing Agency Name

Is the property to be inspected currently Vacant?

Yes No
Preferred Dates and Times of Inspection Date Time
  Date Time
Comments