a. Inspection Requested For Name Current Mailing Address Home Phone Mobile Phone Business Phone Fax E-mail

b. Property to be Inspected Inspection Address (Include Unit No. if applicable) Style of Home Single Family Home Townhouse Condo Other Select One - - - Levels Within Home/Unit 1-Story 1.5-Story 2-Story 3-Story 4-Story 5-Story Select One - - - Number of Bedrooms 0 1 2 3 4 5 Select One - - - Number of Baths 0 1 2 3 4 5 Select One - - - Approx. Age of Home 1 to 5 6 to 20 21 to 40 41 to 60 60 to 100 101 or older Select One - - - Approx. Value less than $150,000 $151,000 to $250,000 $251,000 to $350,000 $351,000 to $500,000 $501,000 to $750,000 $751,000 or greater Select One - - - Are there any additions to structure? Yes Foundation Type Basement Slab Crawl Space Other Select One - - - Furnaces 0 1 2 3 4 5 Select One - - - Water Heaters 0 1 2 3 4 5 Select One - - - Requested Inspection Date Requested Inspection Time Additional Comments or Concerns

c. Environmental Tests Requested Termite $150.00 Yes Radon $175.00 Yes Lead in Water $100.00 Yes Lead Paint $ 50.00 Yes Electromagnetic Radiation $ 75.00 Yes

d. Realtor or Attorney Realtor/Attorney Realtor Attorney Select One - - - Name Company City Mobile Phone Business Phone Email IT IS BEST IF YOU ATTEND THE INSPECTION Note: All utilities must be operative at the time of inspection (Water, Electricity, & Gas)

Before the start of the inspection, you must sign a formal contract. If you will not attend the inspection, we will require it to be faxed to us. If you are at the inspection, our inspector will have it as part of his materials.