Quality Assurance Services
P.O Box 200 Neve Tzuf Israel 71945
Phone: 972 8 923-7869
Fax: 972 8 920-4052
CONTRACT NO CUSTOMER SIGNATURE ID NUMBER DATE OF REQUEST:
CUSTONER FOUND QAS THROUGH: Architect Engineer Advert Seminar Internet Other
CUSTOMER DELIVER BY EMAIL POST MEETING
NAME ADDRESS mailing address same CONTACT INFORMATION (phone)
NAME OF OWNER ADDRESS CONTACT INFORMATION (phone)
ARE PLANS AVAILABLE? YES NO
HAS CUSTOMER REVIEWED THE HOME, OFFICE OR STRUCTURE BEFORE HAND? YES NO
IF NO, WHY NOT?
DOSE THE CUSTOMER HAVE ANY SUSPICIANS ABOUT THE SITE? YES NO
IF YES, DISCRIBE THE ITEM:
1. The inspection ordered is for a commercial or residential structure that either you own or wish to purchase or rent.
2. The purpose of this inspection is to ascertain the general condition of said structure for one of the above reasons.
3. The inspection will note possible defects as well as superior items in the structure and cosmetic items or conditions. If major defects are found it is up to the owner/customer to
investigate the items further with an specialized engineer of their choosing. (Usually the contacting engineer)
4. The inspector is not responsible for the building in any way. The inspection is to be visual only and cannot be held accountable for items missed during tour. This is a good faith inspection
5. Upon completion of the inspection the inspector will deliver the completed inspection as described in the customer information box above.
6. Each inspection is a separate fee of (check one), paid in advance by the party signed below.
A: New structure B: Existing structure C: Pre construction
Series of inspections One time inspection Other -- Specify: Renovation,
(Minimum 4 required) 1200 NIS + VAT 2300.00 NIS + VAT
7. By purchasing an inspection you have agreed to the contract conditions and statements herein.
8. The inspection document is a classified document for the sole use of the purchasing party. Any court appearances requested are 10,000 NIS in advance.
CUSTOMER INSPECTOR DATE
4296/2B (1/2006) SHEET 1 OF 1