Just Print out this form and fax it to (260) 373-1860

Company Name:

Date Ordered: Office: Fax:

Loan Officer: Email:

Borrower Name(s):

Home Phone: Work Phone:

Subject Address:

City: State: Zip Code:

Subject Information

Year Built: Number of Stories: Sq Ft:

Bedrooms: Baths: Garage Size (1 or 2):

Lot Size: Foundation (slab/basement/crawl):

Heating Type: AC (C/A or Window):

Circle One: Full Appraisal – 1004 FHA Appraisal Drive-By Appraisal - 2055

Comments:

Just Print out this form and fax it to (260) 373-1860.