Inspection Order Form

• Enter today's date: -- mm/dd/yy             
•    Press TAB or use Mouse to Move between fields

• Please provide the name of the insured (Owner of building or Site to be inspected) and other contact information:

Inspection Contacts  Name	Tab
Inspection Contacts  Title	Tab
Business Name	Tab
Business Work Phone
Contacts Cell Phone

• Please provide your policy information (who is ordering this report):

Your Company Name:	Tab
Your Name:
Your  Email Address:
Insurance Company Policy#	(required field)
Insurance Company Name
Insurance Agent's Name
Agent's Phone #

• Location to be inspected: (The physical address where we are to do the inspection)

Type all you want in this box, it expands as needed.

• Description of Operations: (What the insured does; type of business)

• Mark applicable coverage's: (What you want us to inspect) (Checking Photo box tells us to take at least a photo of front and side and hazard photo's as necessary)

Property	Building	Contents	Crime
Premises Liability	Glass	S M P	Garage
GKLL	Worker's Comp	Products/CO	OL & T
Commercial Auto	DIC	Quake	Flood
Builders Risk- COC			Photo's

• Additional Instructions: (Add additional instructions in the box below)
• Sprinklers:  Are valves open & locked? Is there a 911 notifier?  Are concealed combustible spaces sprinklered?"
• Photo's will be provided as required:  (You may decline or limit photo's in this section)

(Press CTRL+S to Save a Copy of the completed Form)  (Press CTRL+P to print a copy of the completed Form)