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Client Information
Please provide as much information as possible.
First Name:*
Last Name:*
Address:
Address2:
City:
State, Zip:
State
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IA
ID
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KY
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MT
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NH
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TN
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UT
VA
VT
WA
WI
WV
WY
OTHER
Home Phone:
Work Phone:
Cell Phone:
Fax:
Email:*
Inspection Site Information
Address:
Address2:
City:
State, Zip:
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
OTHER
Property Type:
Single Family Home
Duplex/Multi-Family Home
Age of Home:
Total Sq. Footage:
Heated Sq. Footage:
Foundation:
Slab on Grade
Raised Floor Accessible
Basement
# of Bedrooms:
1 bedroom
2 bedrooms
3 bedrooms
4 bedrooms
5 bedrooms
6 bedrooms or more
# of Bathrooms:
1 bathrooms
2 bathrooms
3 bathrooms
4 bathrooms
5 bathrooms
6 bathrooms or more
Occupied:
Yes
No
Utilities:
Turned On
Turned Off
Inspection Date:
(Requested)
Inspection Time:
(Requested)
Please include any additional information regarding the inspection site:
Notes/Comments:
ValueCheck Home Inspections, Inc.
16489 Hi-Land Tr. • Linden, MI 48451
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