Name  

Method of Contact Phone email other     Contact Phone  

Best time to contact  8-12 AM 12-4 PM 4-8 PM Other                            Date Inspection requested 

E-Mail

Inspection Address

Inspection City                 Approximate SQ FT of House    

 Garage Attached  Yes No Unknown      Number of Baths One Two Three 1 1/2 2 1/2 More than three Don't know   Basement Yes No Don't KNow

House over 40 years old No Yes Don't Know Central Heat Yes No Don't Know Central Air Yes No Don't Know

Are Utilities on Yes No Don't Know    Crawlspace No Yes Don't Know

Agent

Realtor

Radon Test Requested No Yes                   Mold  Test Requested No Yes