CONTACT INFORMATION
Last Name:
First Name:
Company Name:
* Address:
* Zip Code:
* City:
* State:
Email:
Home Phone:
Cell Phone:
Fax Number:
PERSONAL INFORMATION
* Do you have a general liability policy in place?
* Have you been convicted of a felony or DUI within the past seven years? (Do not include convictions that have been sealed, expunged or statutorily eradicated.)
If yes, give date, place, offense, and outcome.
* How did you hear about Field Force Inspections?
Experience
* Do you have any insurance inspection experience?
If yes, please list the companies that you have completed inspections for in the past, both insurance companies and/or field survey companies:
* Are you currently providing inspection services to other companies?
If yes, please list the companies.
LICENSES OR SPECIAL TRAINING
Licensed Home Inspector
Licensed Appraiser
Licensed Realtor
OTHER FIELD SERVICES
Mortgage/Bank Inspections
Claims
Commercial Lines Inspections
EQUIPMENT
* Do you have access to a PC?
* Do you have high speed internet access?
* Do you have a mapping program or software?
* Do you currently have a cell phone?
* Do you currently have reliable transportation?
* Do you have or are you willing to purchase?
AVAILABILITY
* When are you able to completing surveys?
* What mileage radius from your home seed point are you able to cover?
* Please provide a list of cities and/or counties you are willing to cover