You will be contacted promptly for supplemental information and to schedule an appointment.
*
= Required Field
Ordering Agent Information
(Select One)
Agent representing a Buyer
Agent representing a Seller
*
First Name:
*
Last Name:
*
Company Name:
*
Main Office Phone:
(
)
Cell Phone:
(
)
*
Email Address:
Client Information
(Select One)
Buyer
Seller:
*
First Name:
*
Last Name:
*
Home Phone:
(
)
Business Phone:
(
)
Cell Phone:
(
)
*
Mailing Address:
*
City:
*
State:
Select A State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District Of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code:
*
Email Address:
Subject Property
*
Street Address:
*
City:
Cross Street:
*
Age of Property:
*
Square Footage:
*
Property Type:
Select
Single Family
Single Family w/Guest House
Condo
Townhouse
Duplex
Tri-Plex
Four-Plex
Commercial
*
Additions:
Yes
No
*
Stories:
*
Foundation:
Select
Perimeter
Slab
Both Perimeter/Slab
Not Sure
*
The Property is:
Occupied
Vacant
*
Utilities (Gas, Water, Electricity) are:
On
Off
Special concerns or instructions
Report Delivery
Report is mailed to client directly via USPS. Report will also be emailed to the following:
Name:
Email Address:
Name:
Email Address:
Name:
Email Address:
Name:
Email Address:
Payment Options
We prefer to receive payment at the inspection site by cash or check. Payment at time of inspection is required on Listings or Non-Sale Properties. We cannot accept credit cards. When payment is not received at time of inspection, a $25.00 billing fee will be added to the inspection fee.
Select one of the following:
Select
Check/Cash at time of inspection
Bill Escrow
Title Company:
Required If Billing Escrow
Main Phone Number:
Escrow Number:
Escrow Officer:
Closing Date:
How did you hear about our services?
Please select one:
Referral by Real Estate Agent
Referral by Other
Yellow Pages
ASHI Web site
CREIA Web site
Other
Copyright 2004 MaxInspect.Com. All Rights Reserved.
