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Contact Information
First Name* 
Last Name* 
Email Address*
   
Address 
    
City 
State
    Zip  
Home Phone 
Work Phone 
Property Information
Site Address 
   
City 
State
    Zip   
Property Type 
Property Age 
Heated Sq. Ft. 
Total Sq. Ft. 
Foundation Type 
    
# of Bedrooms 
# of Bathrooms 
Occupied? 
   Yes     No  
Utilities On?  
   Yes     No  
Requested Inspection Date 
Requested  Inspection Time 
Realtor's Name 
Realtor's Phone 
   Comments
   		   Additional Information about property
  		 
   

Frank Magdefrau
3152 Big Ben South
Hernando, MS 38632
(Lic. #0234 - Exp 1/2008)
Tel (901) 486-0421
Fax (662) 449-4106
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