Report Release Consent Form Inspection Report Release Please remember that a release form needs to be filed for each individual that you would like to receive a copy of your inspection report. Step 1 of 2 50% Client Name(Required) First Last Client Email(Required) Enter Email Confirm Email Client Phone Number(Required)How would you like the report delivered to recipient?(Required)EmailMailHand Delivered (some fees do apply)Recipient InformationName of Recipient(Required) First Last Recipient Email(Required) Enter Email Confirm Email Recipient Phone Number(Required)Relationship to Client(Required)Real Estate AgentSpouse / Partner (not listed on report)ParentSiblingOtherAdditional InformationAddress of Recipient(Required) Street Address City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Consent(Required)Inspection Report Release Authorization Southern Bound Home Inspections LLC, This document serves as formal authorization from the client of Southern Bound Home Inspections LLC (“Southern Bound”) to allow the release and disclosure of the home inspection report and any related findings or documentation to individuals or parties not originally named or included in the original inspection agreement. The inspection report is the property of the client and is intended for their personal use; however, by this authorization, the client expressly grants permission to Southern Bound Home Inspections LLC, to share the report, in whole or in part, with additional third parties including but not limited to their real estate agent, spouse, partner, family members, friends, legal counsel, or any other individual or advisor the client deems appropriate. The client understands and agrees that this release does not obligate Southern Bound Home Inspections LLC, to provide consultation or explanation of the contents of the report to any third party unless otherwise directed in writing by the client. This release also does not alter, nullify, or supersede the original terms and limitations of liability outlined in the Home Inspection Agreement. Once the report is released to a third party, Southern Bound Home Inspections LLC, shall not be held responsible for how that party interprets, uses, or disseminates the information contained within. This release is being made at the specific direction of the client and Southern Bound Home Inspections LLC, assumes no further responsibility for distribution beyond the parties expressly authorized by the client. Southern Bound Home Inspections LLC, retains the right to require additional written instruction or approval before releasing the report to certain parties, including but not limited to law enforcement, legal representatives not previously designated by the client, the property seller, or the seller’s real estate agent. In such cases, the client will be notified, and any release of information will be made only upon written approval and acknowledgment by an authorized representative of Southern Bound Home Inspections LLC. This measure is intended to preserve the integrity and confidentiality of the inspection process while respecting the client’s right to share their report as they see fit. I certify that I have read & agree to the policies stated.SignatureClient Name(Required) Prefix Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Last Date(Required) MM slash DD slash YYYY Consent(Required) By checking this box, I certify that the information provided is accurate and that I am the client named above. I understand and agree that this submission constitutes a legally binding authorization under the policies and procedures set forth by Southern Bound Home Inspections LLC.CAPTCHA
