Dukes Inspection Service, L.C.   314-660-4737

Inspection Form


Dukes Inspection Order Form
Account Number: *
Name of Insured: *
Survey Address: *
City: *
State: *
Zipcode: *
Contact Person: *
Phone Number: *
Agent Name: *
Requested By: *
Agent Phone Number: *
Email Address: *
Policy Number: *
Type of Business: *
Rating Basis
Payroll: *
Content Amount: *
Building Amount: *
Annual Gross Receipts: *
Type of Inspection
 Vacant Property     Commercial Auto Survey                  Liquor Liability         
 Commercial Fire     Commercial Fire with Earthquake     Premises Liability
 Multi Peril                Garage Liability                                  Builder's Risk  
 Earthquake             Contractor Phone Survey

Additional Buildings on Premises:
Building 2:   
Occupancy: *
Insured Amount: *
Building 3:
Occupancy: *
Insured Amount: *
Building 4:
Occupancy: *
Insured Amount: *
Special Comments:

Gary Dell 
D
ukes Inspection Service  
314-660-4737
   
dukesinspectionservice@gmail.com