Residential Appraisal Request Form

Today's date:

-- mm/dd/yy

Requested by:

First Name
Last Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
E-Mail
Office Phone
Fax Phone
Direct Phone
Other Phone
Referred By

How did you hear about us?

Regular R.A. Field Client Qwest Dex Telephone Book Yellow Book Telephone Book Red Ox Cafe Other

Type of report desired:

---Please Choose--- $ 90 -------- Final Inspection and Recertification of Prior Value $100 -------- Loan Inspection $200 -------- 2075 Drive-By Only (No Opinion of Value) $200 -------- Desk Review $250 -------- 2000 Field Review $275 -------- 2055 Limited One Family Appraisal (Interior/Exterior or Exterior) $275 -------- Vacant Land Value Appraisal (Land ONLY < 10 Acres) $325 -------- 1004 Full URAR FNMA Appraisal (Revised June 1993) $350 -------- 1004 Full URAR FNMA Appraisal (Revised March 2005) $350 -------- 1073 Individual Condominium or PUD Unit Appraisal $400 -------- 1004C Manufactured/Modular/Mobile Homes $425 -------- FHA Appraisal $450 -------- 1004 URAR Hobby Farms (> 10 Acres) and Duplexes $600 -------- 1025 Small Residential Income Property 2-4 Unit Appraisal $___ -------- Per Bid Mileage Fee or RUSH Fee $___ -------- Complex Properties - Including Vacant Land > 10 Acres, Log, Dome & Berm Homes, Homes with Excessive Values for the Average Market Area, Functional Obsolescence and/or External Obsolescence

If you selected "Per Bid" above, please enter amount of bid here:

How would you like your report delivered?

---Please Choose One--- E-Mail Only Hard Copy Only

What is the purpose of the appraisal?

---Please Choose One--- Refinance Sale New Construction PMI Removal Home Equity Estate Dissolution Other

If you selected "Other" above, please enter why here:

Buyer / Applicant:

First Name
Last Name
Work Phone
Home Phone
Fax

Seller / Occupant:

First Name
Last Name
Work Phone
Home Phone
Fax

For Entry Contact:

First Name
Last Name
Work Phone
Home Phone
Fax

Property Information:

Property Address
City, State and Zip
Legal Description
PID Number
County
Cost or Value
Mortgage Amount

THANK YOU FOR YOUR ORDER!  HAVE A NICE DAY!