Participate

Type Of Participant:

Client Realtor

*Name:

*Phone Number:

*Email:

*Address:

Date and Address of Inspection:

Report Number:

Inspector's Name:

Please rate the following (1=poor / 5=excellent):

General satisfaction with us :

1 2 3 4 5

Inspector's communication skills :

1 2 3 4 5

Confidence in inspector's ability :

1 2 3 4 5

Usability of the inspection book :

1 2 3 4 5

How did you get our name:

Internet

Friend or relative

Real estate agent

Yellow pages

Business card

Brochure

Lawyer

Banker

TV

Magazine

Other

Was there anything about our services that you especially liked?:

Was there anything about our services that you didn't like?:

Would you be happy to act as a reference?:

YesNo

Please enter your comments, suggestions or questions:

Would you like to be on our mailing list
to receive a monthly tip on the home inspection

Yes No

Will you permit us to display your comments on our website?:

YesNo