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We look forward to help make your dreams come true!

Please fill in this simple form so that we can best serve your needs as conveniently for you as possible. Fields marked with a red asterisk (*) are required and we cannot process your request without answers to these fields.

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Appointment Request

Your Name*
Your Email*
Your address
Daytime Phone*
Home Phone*
Mobile Phone

Information about the Home to be Inspected:
Address
City
State
Approximate Square Footage
Number of bedrooms
Number of bathrooms
Age of home

You are the:
If you are not the realtor:
Realtor Name:
Realtor Company
Office Phone:
Mobile Phone:

Please choose a time when we can perform the inspection

First Choice:
at

Second Choice:
at

Please identify the service(s) you are requesting The BrickKicker professional to arrange for you.

Property Inspection:

	Single Family
	Townhouse
	Condominium
	Multi-Unit
	Manufactured Home
	New Construction with Punch List
	New Construction/Builder’s 12 Month Warranty
	Home Maintenance Review (HMR)
	Other:

Ancillary Services:

	Termite/Pest Inspection
	Radon
	Pool
	Spa
	Well
	Septic
	Other Environmental Testing (i.e. Lead paint, lead water)

	FHA/VA Certifications
		Structural
		Electrical
		Plumbing
		Roof
		Other:

Note: Not all of the above services are offered by each BricKKicker franchise. Your local BrickKicker will notify you of the services offered.

Comments:

Thank you for selecting The BrickKicker to be a part of your home buying experience. Your local The BrickKicker professional will contact you shortly to confirm your request.