Lender/Client
Attention
Lender Address
Lender Telephone
Lender FAX
Lender Email
Property Address
City
Legal Description
Borrower/Buyer
Home Telephone
Work Telephone
Mobile Telephone
Seller/Occupant
Home Telephone
Work Telephone
Mobile Telephone
Sales Price $
Proposed Mortgage $
Realtor/Company
Telephone
Mobile Telephone
Loan Type
Conventional
FHA
Home Equity
Refinance
Case Number if FHA Loan
Appraisal Type
Full
Interior/Exterior
Drive By
Vacant Land
Other (Explain below)
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