Client VerificationI verify that I am the client/purchaser of this property*Please Select An OptionYes, I am the client/purchaser of this propertyNo, I am a real estate agentOtherI verify that I read the entire inspection report when it was sent to me*Please Select An OptionYesNoContact InformationName* First Last Email Address* Phone Number*Inspection Address* Street Address City Important DatesHome Inspection Date* Date Format: MM slash DD slash YYYY Closing Date* Date Format: MM slash DD slash YYYY Possession Date* Date Format: MM slash DD slash YYYY Date When You First Noticed the Issue* Date Format: MM slash DD slash YYYY Date of Your Final Walkthrough Before Closing* Date Format: MM slash DD slash YYYY Issue DetailsWas the Issue Apparent at the Final Walkthrough?*Please Select An OptionYesNoDid Not Do a Final WalkthroughHave You Consulted With a Contractor On This Issue?*Please Select An OptionYesNoWhat Did the Contractor Say About the Issue?Upload Any Contractor Bids/Estimates Here Drop files here or Was the Home Sold With a 1-Year Home Warranty in Place?*Please Select An OptionYes, I have not contacted them about the issueYes, I have contacted them about the issueNoWhat is the Name of the Home Warranty Company?What Did the 1-Year Home Warranty Company Say About the Issue?Was the Issue in the Seller's Disclosure Document?*Please Select An OptionYesNoUpload a Copy of the Seller's Disclosure HereUpload a Copy of the Seller Request for Repairs HereWas the Home Ever Sold "As-Is"?*Please Select An OptionYesNoWas the Home Ever Bank Owned?*Please Select An OptionYesNoDo You Currently Occupy the Dwelling?*Please Select An OptionYesNoWhat is the Issue You Are Experiencing?*Upload Any Images of the Issue Here Drop files here or How Would You Like the Issue Resolved?*Signature*Before You Hit Submit, Please Make Sure This Form is Completely Filled Out. Also, if You Have Not Contacted Your Home Warranty Provider, Home Owner's Insurance, or Gotten Bids For Repairs From a Contractor Then it is Recommended That You Do So Before Submitting This Form. By Signing Above You Attest That the Above Information is True & Correct.