SPMGA Southern Preferred MGA, Inc.
13465 Midway Road, Suite 202
Dallas, TX 75244
214-703-9900 - Fax 214-703-9624
  1. Applicant's name
  2. Business name
  3. Physical Address
    City  State  Zip 
  4. Phone  Fax  Email 

  5. Licensed Inspectors TREC License # or File ID # % of ownership years licensed
  6. What was the total gross revenue in the last 12 months from inspections?   $
  7. What was the total number of inspections performed in the last 12 months? 
  8. Y  N Has the applicant or any listed inspector been subject to disciplinary action by any State Agency?
  9. Y  N Have any claims or suits been made against the applicant or any listed inspector in the last five years?
  10. Y  N Is the applicant or any listed inspector aware of any issues, circumstances, errors, omissions, or offenses which may result in a claim being made against the applicant, any listed inspector, or the business?
  11. Please describe any recent claims or issues which might result in a claim


    I certify that I have read the questions above, and have answered each truthfully and completely to the best of my knowledge

    By placing the initials of the applicant in the box below, the applicant acknowledges acceptance of the above, and understands that the initials carry the effect of a signature.

    Initials Date Name of applicant Title