Contact Haag Engineering Now to Submit an Assignment

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

You will receive an email confirmation of the assignment shortly after completing this form. If you do not receive an email, please call us at 214-614-6500.

General Assignment Information

Date:	3-Feb-2012
Preferred Engineer	Please Select... Behrens, Daniel B., P.E. Bond, Anthony E., P.E. Boudreaux, Donald T., P.E. Cain, Crystal R., P.G. Cox, Edward P., Ph.D, P.E., C.W.I. Danielson, Robert A., P.E. Fleishmann, Robert N., P.E. Gardiner, Matthew R., P.E. Gilvary, Kenneth R., P.E. Goode, Jonathan S., Ph.D., P.E. Herzog, Richard F., P.E., R.R.C. Jenner, R. Kean, III, P.E. Kestner, Justin T., P.E. Kirkpatrick, Carroll Stone (Stoney), P.E. Marshall, Timothy P., P.E. - Meteorologist Morrison, Scott J., P.E. Olsovsky, Denis D., P.E. Patnode, Shawn, E.I.T. Plancer, Ryon, P.E. Reisner, Freeman E., P.E., C.F.E.I., C.V.F.I., C.F.I.I. Reutlinger, Chris, P.E. Sitzmann, Matthew J., P.E. Smith, Steve R., P.E. Stepanchak, George J., P.E. Stewart, John D., P.E. Sticht, Wade, P.E. Strasser, Timothy D. , P.E. Taylor, Terry C., P.E. Teasdale, David L., P.E. Wiethorn, Jim D., P.E. Williams, Paul R., P.E. Wlascinski, John Z., P.E., C.F.E.I. Zielinski, Chad, P.E.
Report Preference*	PDF  Hard Copy  Both
Report Discipline Type check all that apply.	Commercial   Construction   Industrial  Residential   Transportation   Other
Report Type check all that apply.	Construction Defect Evaluation   Crane   Electrical   Explosions / Accidents   Fire C&O   Foundation   Geotechnical   Hail   Mechanical Evaluation   Moisture  Natural Causes   Premise Liability Evaluation   Product Failure Analysis   Structural   Wind   Other

Requesting Party

Name*
Title
Company
E-mail Address* Privacy
Retype E-mail*
Office Phone
Cell Phone
Fax
Address
Address 2
City
State / Province	-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Washington DC Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachussetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming (USA and Canada)
Zip / Postal Code
Country	-Select- United States of America Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile
Local Contact (if different)

Responsible Party (if different)

Name
Title
Company
E-mail Address Privacy
Office Phone
Cell Phone
Fax
Address
Address 2
City
State / Province	-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Washington DC Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachussetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming (USA and Canada)
Zip / Postal Code
Country	-Select- United States of America Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile
File / Reference Number

Assignment Information

Job Name*
Date of Occurence
Address
Address 2
City
State / Province	-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Washington DC Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachussetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming (USA and Canada)
Zip / Postal Code
Country	-Select- United States of America Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile
Inspection Location (if not "Address")
Contact Person
Home Phone
Cell Phone
Work Phone
File / Reference Number
Purpose of Work

Roofing-Specific Information

If this is a roof inspection, please fill out this section.
Roof Type:	Composition   Concrete Tiles   Clay   Fibercement  Metal Panels   Tile   Tile Slate   Wood
Pitch of Roof:	:12
Stories:	1   2   3
Approx Sq. Ft.
Can you access roof with 1-story ladder?	Yes   No
Ladder on site?	Yes   No

Other Information

Additional Comments
Attachments	(maximum attachment: 10MB; only files of the following type are allowed: PDF, DOC, XLS, ZIP, JPG, PNG)

Please type the code for verification:	Refresh Image (NOTE: this form expires in 24 hours)