OWNER INFORMATION

*(required information) * Owners Name * Property Address * City/Town Zip Code Mailing address City/Town Zip Code * Home phone Work phone Cell phone Fax line *E-Mail Address back to top or skip to bottom

REALTOR INFORMATION

Agents Name Brokerage name City/Town Work phone Cell phone *E-Mail Address Realtor comments / Special instructions back to top or skip to bottom

ESCROW INFORMATION

Escrow Officer Escrow Company City/Town Escrow number back to top or skip to bottom

SEND TO OTHER REALTOR

Other Agent Name Brokerage name? Mailing address City/Town Zip Code Home phone Work phone Cell phone Fax line E-Mail Address back to top or skip to bottom

DISTRIBUTE COPIES TO

Additional copies to :Realtor Escrow Other

square footage: under<1000 1001 - 1500 1501 - 2000 2001 - 2500 2501 - 3000 3001 - 3500 3501 - 4000 4001 - 5000 over >5000 approximate age: New 1-10 years 11-20 years 21-30 years 31-40 years 41-50 years over 50 yrs check appropriate boxes: Concrete slab Raised floor (subarea) Attached wood decks Detached structures (list below) Special instructions:

We will be calling you to schedule a convenient time to perform your inspection. Please provide a daytime phone number where you may be reached.