Date: Property Address:

From
Name: Company: Address:

Phone:    Fax:   E-Mail*: *Required

Appraisal Type:       Sale Price $

Number of Copies:   Refinance Estimated Value $

Property Type:     Value as is $    As completed $

Form Type:  1004   2055 Other    Borrower C.O.D. Yes     No  

Invoice Lender

Delivery Instructions: (Check one please):    Regular Mail    E-Mail     Pick up

Owner/Seller Name: Borrower/Buyer Name:

Legal Description:

Contact For Inspection:

Special Instructions:

Contract attached? Yes
               (If you checked Yes, please send Contract via separate E-Mail)  Click & Attach Contract Here Via E-Mail