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ASSURED REAL ESTATE APPRAISAL SERVICES, INC. CUSTOMER ORDER/ACCOUNT APPLICATION Company Name (if applicable): ___________________________________________________
Title (if applicable): __________________________ Name (First/Last)*: ____________________________________________________________ Street Address*: ______________________________________________________________ City/State/Zip*: _______________________________________________________________ Phone*: _______________ Fax: _____________________ Email*: _______________________ Property Type (X): ___Detached ___Attached ___Condo ___PUD ___CO-OP Occupancy Status (X): ____Primary Residence ____Second Home ____Investment Property Type of Loan (X): _____Conventional ______FHA ______VA ______USDA/Rural Housing Service Lien Position(X): ______First Mortgage ______Second Mortgage Appraisal Purpose (X): ________Purchase _______Cash-Out Refinance ______No Cash-Out Refinance Type of Appraisal (X): ____Interior/Exterior (Full) _____Exterior Only _____Market Rent Analysis Property Address*: Name on Deed (First/Last or Company)*: ______________________________________________ Street Address*: _________________________________________________________________ City/State/Zip/County*: ___________________________________________________________ Contact for Entry*: Name _____________________ Home: _______________ Work:___________ Total Amount*: $_____________ Date*: ____________ Credit Card Type(X)*: _______Visa _______ MasterCard _______American Express Card Number*: ____________________________________ Expiration (month/year)*:___________ Name (as it appears on card)*:_________________________________________________________ Street Address (of credit card holder)*:__________________________________________________ City/State/Zip (of credit card holder)*:___________________________________________________ (I AGREE TO PAY THE ABOVE TOTAL AMOUNT ACCORDING TO THE CARD ISSUER AGREEMENT) PLEASE FAX THE COMPLETED FORM TO ASSURED REAL ESTATE APPRAISAL SERVICES AT (301) 567-9588 OR EMAIL TO: tdeanes@assuredreports.com |