Name *
E-Mail *
Phone Number *
Message *
Property Address *
Date of Inspection *
Date Concern Was First Observed *
Date of Closing *
Date of Move In *
Detailed Description of Incident or Concern *
Was the condition observable at the time of the inspection? *YesNo
Did you learn of this condition prior to closing? *YesNo
Did the seller provide any type of disclosure form? *YesNo
Did you conduct a final walk through? *YesNo
Date of final walk through? *
If you did not notice the condition yourself, who first brought it to your attention? *
Was any action taken on this condition prior to closing?YesNo
Was any action taken on this condition after closing?YesNo
Were any other inspections/services performed by other service providers as of the purchase process?YesNo
Provide contact information for any contractors, service persons or other individuals that have identified, inspected or performed work related to the incident: List name, contact information, and comments they have regarding the incident.
Please provide additional comments regarding your knowledge of the condition
Signature (by signing your name or initials here, it will act as your electronic signature) *
