Name:   
Address:   
City / State / Zip:         
Home Phone: 
Work Phone: 
Cell Phone: 
Email: 
Contact Via: 
Please briefly describe your drainage problem:
To provide our inspectors with additional information about your drainage problem, please answer the following questions:
Do you have a basement?
Do you have a sump pump?
Does water pond in your yard following a rain event?
Do your roof downspouts discharge to your yard?
Please provide any additional information that you think our inspectors might find useful:
Do you agree to the terms and conditions provided below?

 
TERMS AND CONDITIONS 
INDEMNIFICATION AND HOLD HARMLESS. In submitting this inspection request, HOMEOWNER hereby agrees to defend, indemnify and hold harmless the VILLAGE, and all of its agents, board of trustees, officers, administrators, agents, and employees ("Indemnified Parties"), to the fullest extent permitted by law, from and against all claims, damages, actions, liabilities, losses (including economic losses), injuries, lawsuits, costs, expenses and liens, including but not limited to, reasonable attorneys' fees, relating to HOMEOWNER's participation in the PROGRAM. Any costs or expenses, including reasonable attorneys' fees, incurred by Indemnified Parties to enforce the indemnification obligations hereunder shall be borne by HOMEOWNER.