Submit a Claim

Your Name

First

Last

Phone

Name of Your Inspector

Address of Inspected Property

Street Address

Suite or Apartment #

City

State

Zip/Postal

Date of Your Inspection

When Did You Notice the Issue?

Date of Closing

Date of Move In

Please provide a detailed description of the claim.

Was the condition observable at the time of the inspection?

Yes

I don't know

Did the seller provide any type of disclosure form?

Yes

I don't know

Did you conduct a final walk-through?

Yes

I don't know

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?

Yes

Was any action taken on this condition after closing?

Yes

Were any other inspections/services performed by other service providers as of the purchase process?

Yes

Please provide the contact information for any contractors, service providers or other individuals that have identified, inspected or performed work related to the incident. Include their name, contact information and any comments they have made regarding the incident.

Please upload any relevant images or files.

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Signature

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