Seller Information
Seller's Name:
Property Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Guam Puerto Rico None
Zip Code:
Seller's Phone:
Age of Structure:
Lock Box?	Yes             No
Occupied?	Yes             No
Type of Loan:	Conventional FHA VA Cash Other
Termite Warranty Status:	D & L Pest Control Other None
Structure Information:	Crawl Space Basement - Finished Basement - Unfinished Slab
Stucco?	Yes             No
If yes, what type?	Synthetic      Hardcoat
Status of Letter:	Pre-listing     Closing

Purchaser Information
Purchaser's Name:
Purchaser's Phone:
Closing Date:

Other Information
Payment Method:	Paid at Closing Credit Card Check
How would you like to receive your inspection report?                Mail                Pick-Up                Leave
If leave, where?
D&L Inspector Requested:
Additional Information: