HOME INSPECTORS APPLICATION
Complete form and Submit online or Download the Adobe Acrobat version and fax to 206.378.1136

1. CONTACT INFORMATION
    Name of Applicant:
    Street Address:
    City, State, Zip:
    Phone Number:

Fax Number:

2. YEAR ESTABLISHED: (if less than 3 years attach resume)
3. STAFF (INDICATE NUMBERS)
    Full Time:
    Part Time:

# Years Experience:

    Principals/Partners/Officers:
    Inspectors:
    Other Employees (clerical):
4. PLEASE COMPLETETHE FOLLOWING:
 
Current Year
Next Year
   Number of Inspections:
   Inspection Fee per Inspection:
   Gross Annual Revenue:

5. TYPE OF INSPECTION:
    Structural:
%
   Mechanical:
%
    Pest:
%
   Mold:
%
    Safety:
%
   Construction:
%
    Septic/On-Site Sewage:
%
   Other (Describe):
%
    Total (should equal 100%)    
%
6. Residential

 

      
    Commercial/Industrial:

 

    

%
    New Construction:

 

    

%
    Total (should equal 100%)

 

    

%
7. SOURCE OF BUSINESS:
    Individual Seller:    
%
    Prospective Buyer:    
%
    Real Estate/Relocation Company:    
%
    Finance Company/Mortgage Broker:    
%
    Total (should equal 100%)

 

    

%
8. Are you on exclusive home Inspector for any one realtar or real estate company?
   If yes, provide on explanation:
9. Are you a licensed real estate agent?
     If yes, do you Inspect hames which you have listed as a real estate agent?
10. Are you a builder, contractor or repair/remodeling contractor?
     If yes, do you provide any of these services to the some properties you Inspect?
11. What percentage of your work is subcontracted? %
     Do you require subcontractors to carry their own Professional Liability Insurance?
     If yes, do you obtain a certificate of Insurance?
12a. What type of Inspection report do you use? Narrative     Checklist     Verbal
12b. What inspection standards are used?

ASHI     NAHI     NACHI     FABI     GAHI     CREIA

   Other - Describe:
12c. Do you currently use a pre-inspection agreement when performing a home Inspection?
12d. Are the agreements signed in advance by your customer?
12e. Do you offer any warranties or guarantees?
      If yes, provide on explanation:
13. Are you a member with any of the professional home Inspections organizations?

ASHI     NAHI     NACHI     FABI     GAHI     CREIA

   Other - Describe:
14. PREVIOUS COVERAGE:
     Professional Liability
     Policy Period:
     Carrier:
Limits:
     Deductible:
Premium:
     Is coverage written on a claims made policy form?
      If yes, please provide the effective date:
15. GENERAL LIABILITY:
     Policy Period:
     Carrier:
Limits:
     Deductible:
Premium:
     Is coverage written on a claims made policy form?
      If yes, please provide the effective date:
16. LIMITS OF PROFESSIONAL LIABILITY LIMITS REQUESTED:

     Deductible Requested:

$100,000     $300,000     $500,000     $1,000,000    

$5,000        $10,000       $25,000      Other

17. Have any claims been made against your firm or anyone indicated in question #7?
18. Are you aware of any act, error, omission or other circumstances which might reasonably be expected to be the basis of a claim or suit against you or anyone indicated in question #3? ?
19. During the past live (5) years has any insurance company declined, cancelled or refused to renew coverage for the applicant or anyone named in question #3?
      If yes, provide on explanation:
       
Name:
Position:
     
       

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