Home Inspector Application
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5From The Office of Secretary of State
HOME INSPECTOR APPLICATION
Initial Application
Renewal Application
For Office
Date Received
Date Issued
Use Only
Applicant Name
Home Inspector Registration #
(Please Type or Print in Dark)
For Office Use Only
Street Address or P. O. Box
Apartment #
City
State
Zip Code
Home Telephone #
Social Security No..
Employer I.D. No
Business Name
Street Address or P. O. Box
Suite #
City
State
Zip Code
Business Telephone #
Applicant is Doing Business as:
Individual Proprietorship
Individual Proprietorship
L. L. C.
L. L. C.
Partnership
Partnership
Franchise
Franchise
Corporation
Corporation
Individual Proprietorship
Individual Proprietorship
L. L. C.
L. L. C.
Partnership
Partnership
Franchise
Franchise
Corporation
Corporation
If you checked above that the business is a partnership, you must list the name and address of each
partner below
OR
If you checked above that the business is a corporation, L.L.C., or franchise, you must list the names
and address of the corporate officers and the statutory agent for service. (Please place a check mark
[!] by the statutory agent.)
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Insurance Certificate:
The enclosed insurance certificate must be completed and submitted to our office by an Alabama-
licensed insurance company as proof of your having obtained liability and property damage
insurance
Name of Insurance Company:
Policy No.:
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