Physical Street Address:                 City: 

Zip Code:                                             Property Type:   Single Family Condominium Cooperative Detached Duplex Triplex Fourplex Vacant Land Vacant Lot

Current occupancy of property:  New Construction - Vacant Owner Tenant Vacant    Approx Sq Foot:

Age:        Detached Garage/Shop: Yes    No 

Inspection contact:  Borrower Co-Borrower Occupant Owner Realtor Other                    Contact name: 

Contact phone:                 Contact E-Mail: 

Best day(s) for inspection:  Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Additional Comments or Instructions to the Inspector - please include the date and time you would like your inspection: