Client Name* Contact Email* Contact Phone Number*Address* Date of Inspection* MM slash DD slash YYYY Date of Concern First Observed* MM slash DD slash YYYY Date of Closing* MM slash DD slash YYYY Date Moved In* MM slash DD slash YYYY Was there a Home Warranty Purchased* Yes No N/A Detail Description of Incident/ConditionDo you have Pictures or Video?* Yes No N/A Do you have capabilities to share the pictures or videos?* Yes No N/A Did you learn of this condition any time prior to closing?* Yes No N/A Did the seller provide any type of Disclosure Form?* Yes No N/A Did you conduct a final walk through?* Yes No N/A Date of Final Walk Through* MM slash DD slash YYYY Was any action taken on this condition prior to closing?* Yes No N/A After closing?* Yes No N/A Were any other inspections/services performed by other service providers as of the purchase process?* Yes No N/A If so, please provide information for any contractors, service persons, or other individuals that have identified, inspected, or performed work related to the incident:Name Phone NumberTheir CommentsDid you obtained an estimate or proposal to correct the condition?* Yes No N/A Amount of estimateHas any work been done?* Yes No N/A Please upload any pictures and/or support documents that you may have. Drop files here or Select files Max. file size: 2 MB. Client Name* Client Signature*Date* MM slash DD slash YYYY Δ
