About YouPlease tell us about yourself and how to contact you.First name*Last name*Your Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone number*Best time to callAbout the InspectionPlease tell us about the inspection.What is the property address? Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Same as above Inspected Property Address is same as aboveWhich BrickKicker Location did you work with?*The BrickKicker Location Near You*Bend, ORBradenton, FLCedar Falls, IACentral, WIChamplain Valley, VTChicagolandColumbus, OHConejo Valley, CADallas, TXDeKalb CountyDes Moines, IADetroit, MIEast Central, MOGeorgiaGwinnett, GAHampton Roads, VAIndianapolis, INMadison, WINashville, TNNorth East, INPalm Beach, FLPittsburgh, PAPlacerville, CAQuad Cities, IASanta Barbara, CASioux Falls, SDSouth West, MISoutheast, WISpringfield / BloomingtonSt. Louis, MOWest Central, OHYuma, AZWhat was the name of the inspector? First Last When did the inspection take place? MM slash DD slash YYYY Describe any questions or concerns with the inspection.*Write as much as you need to.Are the questions/concerns described above mentioned in the inspection report? No, the questions/concerns are not mentioned in the report. Yes, my questions/concerns are mentioned in the report.When did you first notice the issue? MM slash DD slash YYYY How did you become aware of any issues?Did you accompany your inspector on the inspection? No, I was not there during the inspection. Yes, I accompanied the inspector during the inspection.If you can remember, describe the weather that day.Did you receive a copy of the inspection report? No, I did not receive a copy of the inspection report. Yes, I have a copy.When did you receive the report? MM slash DD slash YYYY Please upload a copy of the report:Max. file size: 50 MB.Include additional comments if you want to.Have you paid for your inspection? No, I have not paid for the inspection yet. Yes, I paid for the inspection already.What is the exact name of the company you paid?Did you receive a Seller's Disclosure from the seller of the property? No, I don't recall receiving a Seller's Disclosure. Yes, I received it and the seller mentions the issue. Yes, I received it and the seller didn't say anything about the issue.Please upload a copy of the Seller's DisclosureMax. file size: 50 MB.Include additional comments if you want to.Have you taken any steps to repair the issue? No. I have not taken any steps to repair. Yes.Please explain what steps you have taken to address the issue.Do you have a copy of your pre-inspection agreement? No, I don't have a copy. Yes, I have a copy.Please upload the agreement.Max. file size: 50 MB.Include additional comments if you want to.What outcome would you accept to resolve this issue?Any final comments?CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.Δ
