Haag Engineering Co. Failure and Damage s
 

Request Engineer Inspection
Please complete form below to request an engineer inspection. You may wish to print out a copy of this page for your own records before submitting the form. You may also print and fax the form to (214) 614-6501.

You will receive a faxed confirmation of the assignment within one business day of the assignment. 
Date:
Please Complete and Submit and/or Fax to Haag at (214) 614-6501 Phone (800) 527-0168
Please Note: Use the TAB key to move to the next field and ENTER or RETURN to submit the form.
Attention
Report Preference  PDF   Hard Copy   Both
Client Information
First Name
Last Name
Title
Company Name
E-mail Address
Privacy
Phone
Fax
Address
City
State/
Province		 (USA and Canada)
Zip/Postal
Code
Country
Assignment Information
Property Owner
Date of Loss
Inspection Address
City, State, Zip
Contact Person
Home Phone
Work Phone
Claim, File, Policy No.
Adjuster
Cell Phone
Pager
Purpose of Work
Additional Comments
If this is a roof inspection, please fill out this section
If flat, please check the type:  Composition   Concrete Tiles   Clay   Fibercement
 Metal Panels   Tile   Tile Slate   Wood
Pitch of Roof: :12
Stories:  1   2   3
Walkable:  Yes   No
Approx Sq. Ft.
Can you access roof with 1-story ladder?  Yes   No
Ladder on site?  Yes   No
Ladder by others?  Yes   No
Ladder by Haag?  Yes   No
Additional helpful info:
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