Address to be inspected       City

Foundation (check one) Pier & Beam    Concrete Slab          Square Footage (including garage)

The home is (check one) Occupied    Vacant     Are the utilities on? Yes    No    Don't know

Is there a lock box? Yes    No     Suprakey Access? Yes    No    If not, who has the key

Who plans to be present? Buyer    Seller    Other

(No one has to be present - this is optional - if you would like to be present, please let us know)

Which inspections would you like to purchase?

     Home Inspection             Gas Shut-In Test            Radon Test             Sprinkler Test

     Septic Walk-Over            Septic Dye Test             Termite Inspection*

     Culturable Fungi Test     Viable & Non-viable Fungi Test           Identification of visual mold

PURCHASER'S INFORMATION

Name   Email Address

Current Address

City State   Zip Fax

Phone numbers Home   Work Cell

REALTOR'S INFORMATION

Buyer's Realtor     email

Realtor numbers fax   Work Cell

Seller's Realtor     email

Realtor numbers fax   Work Cell

Title Company   Who gets the inspection report?

Special Instructions

PURCHASE AGREEMENT

By typing my name and the date into the following boxes, I am agreeing to allow this to be my digital signature. I am stating that I am the purchaser of the reports ordered and accepting responsibility for payment. I understand that if I do not pay for the reports at the time of inspection, there will be a $50 fee added to the total. I can leave the payment with my realtor on the day of inspection to avoid paying this fee.  I also understand that, should I choose not to purchase the property listed above, I am still responsible for payment of the inspections ordered.

I will pay for my inspections

        On the day of inspection by leaving checks with my realtor.

        I will pay in closing, please fax invoice to my title company.

        I plan to be at the inspection and will pay the inspector.

Signature    Date