INSPECTION REQUEST FORM
	Please fill in as much information as you have available to assists us with our scheduling and pricing of the inspection. Be sure to fill in name and contact information so we can get back to you, even if you do not want to fill out the rest of the form. Buyer's Name: Buyer's Street Address: Buyer's City: Buyer's State: Buyer's Zip Code: Buyer's Home Phone: Buyer's Other Phone: Buyer's Email Address: Buyer's Realtor: How Would You Like Us to Contact You: (Check All That Apply) Home Phone Other Phone Email Call My Realtor Other (See Special Requests Below) Time Frame for Inspection: As Soon As Possible Within Next 5 Days Within Next 10 Days Other Seller's Realtor Firm (Sign In Yard): City of Home to Inspect: County of Home to Inspect: Carrol Cass Clinton Grant Hamilton Howard Miami Tipton Other Approximate Square Feet of Home: 1-1300 1301-2000 2001-2500 2501-3000 3001-4000 4001-5000 5001-6000 6001-8000 Over 8000 Other Approximate Age of Home: New-5 Years Old 6-10 Years Old 11-30 Years Old 31-50 Years Old 51-100 Years Old Over 100 Years Old Condition of Home: New Good Average Rough Other Configuration of Home: Crawl Space Basement Crawl Space & Basement Concrete Slab Concrete Slab & Crawl Space Concrete Slab & Basement Other Number of Stories/Levels: 1 2 3 Bi-Level Tri-Level Story and A Half Other Would Buyer Like to Attend Inspection: Yes No Maybe Other Is House Currently Lived In or Vacant: Lived In Vacant Furnished but Vacant Other Inspection Services Requested: (Check All That Apply) Full ASHI Home Inspection Septic System Dye & Stress Test Well System & Evaluation Wood Destroying Insect Inspection Water Testing Radon Measurement Other Water Tests: (Check All That Apply) Bacteria (Coliform & E. Coli) Nitrates Sulfates Lead All of the Above Other None Special Requests: Request Specific Inspector: Gil Hendrickson Paul Munoz Either

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