Technical Assistance Consultancy Inquiry Form

Please choose the category that best describes your need for a TAC *

• Safety Concern
• Temporary Recommendations/Scope of Work
• Second Opinion
• Funding Logjam
• Other (please explain)

Other:

Please provide the address of the building or structure in need of a TAC *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Who owns the building? *

Is the owner a *

• 501c3 nonprofit organization
• Municipality
• Private entity

Please provide the name, mailing address, telephone number, and email address of the owner *

First

Last

Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone *

Email *

In detail, please describe the issue that needs to be addressed by a TAC *

Please detail how your organization has determined there is a need for a TAC—visual observation, building inspector, engineer, architect, contractor, etc. *

Provide a photo of the ENTIRE building or structure *

Drag & Drop Files, Choose Files to Upload

Provide photo(s) or any areas of concern (if applicable)

Drag & Drop Files, Choose Files to Upload

Provide photo(s) or any areas of concern (if applicable)

Drag & Drop Files, Choose Files to Upload

Submit