Construction Defect Intake Form
Confidential Attorney-Client Privileged

Owner(s) Name(s) *:
Address *:
City *:
State *:
Zip *:
E-mail *:
Phone *:
Fax:
Location of damaged home if different from above:
Address:
City:
State:
Zip:
Is the home rented? Yes No
What problems are you having with your home:
Have you ever had any repairs or warranty work on your home? Yes No If so, please explain:
What is the name of the person and company who did the work on your home?
Have you had any problems or concern with the following: ROOFS Have you noticed any problems with roof such as loose tile or staining? Please explain: WINDOWS Have you noticed any problems with windows, hard to open, dusty, water stains? Please explain: OTHER Please describe any concerns or observations about defects/damage not covered above: Please be advised that by completing this form Wike Killip has not agreed to take your case. This form will allow us to evaluate your claim and contact you to decide whether or not we will take your case.