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Date
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Ordered By / Loan Officer
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Company Name
Company Address
City / County
State
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Zip
Phone Number
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Fax Number
Email For Report Delivery
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Property Address
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City / County
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State
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AL
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AR
CA
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CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
US
UT
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VA
WA
WV
WI
WY
Zip
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Borrower
*
Phone Number
*
Owner
Phone Number
Additional Contacts
Additional Phone Number’s
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(Fees may vary for values over $1,000,000 or type of dwellings and locations)
1 Fam $350
2 Fam $500
3 Fam $525
4 Fam $550
Condo $350
Condo Exterior $300
Co-op $350
Co-op Exterior $300
2055 Exterior $250
1 Unit Field Review $200
2 - 4 Unit Field Review $225
Desk Review $175
Recertification $ 1/2 of Original Appraisal Fee
Final Inspection $150
Loan Purpose
Refinance /
Purchase /
Other
Please specify if Other
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Loan Type
Conventional /
FHA
FHA Case Number
Estimated Market Value
*
Purchase Price
Mortgage Amount
Sellers Concessions
Rental Income If Multi-Family
Unit 1
Unit 2
Unit 3
Unit 4
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