Homeowner/Agent PICRA Submission Form
Homeowner's Name
First Name
Last Name
Homeowner's Phone Number
Homeowner's E-mail Address
Address of Property
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Agent's Name
First Name
Last Name
Agent's Phone Number
-
Area Code
Phone Number
Agent's E-mail Address
Is the home occupied or vacant?
*
Occupied
Vacant
If the home is occupied, who do you prefer we reach out to for scheduling inspections/repairs?
Homeowner
Agent
If the home is vacant, is there a contractor (not REIN) lockbox?
Yes
No
If the home is occupied, who do you prefer we reach out to for scheduling inspections/repairs? (Homeowner or Agent)
If the home is vacant, is there a contractor (not REIN) lockbox? (Yes or No)
If there is a contractor lockbox, what is the lockbox code?
What is the scheduled closing date on the home?
Any additional information you'd like to provide?
How did you hear about us?
Newspaper
Facebook
Instagram
Google
Magazine
Other (Please specify below)
If 'Other', please specify in box below.
Other
Upload Home Inspection Report
*
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Upload PICRA List
*
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If you have any additional documentation or photos that you think may be useful for us to review, please upload them here:
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