Online Signature Form Please fill out the fields below and read the below information carefully. Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Our reports are the results of the visual inspection done at the time of inspection. It is intended as a convenience to our customers, not as certification of fire worthiness or safety. Since conditions of use and hidden construction defects are beyond our control, no warranty is made for the safety or function of any appliance and none is to be implied.By checking this box and signing below, I verify that I have read this form and understand the apparent condition of my fireplace, appliance, chimney, and/or vent system. Furthermore, I understand the limitations of the report as given in the paragraph above.* Check this box and sign below to verifySignatureEmailThis field is for validation purposes and should be left unchanged.