REQUEST AN APPRAISAL

Please fill out the information that applies in the form below and submit. We will respond to your request as soon as possible.

Contact Information:

Full Name:

Company name:

(if applicable)

Phone number:

Fax number:

E-Mail address:

Address:

City:

State:

Zip:

Property Information:

Borrower's name:

Property to be appraised:

Property zip code:

County the Property is located in:

Property Type:

Estimated Price Range:

Purchase Price If Applicable:

Loan Amount

Appraisal Information:

Report Desired:

Appraisal Purpose:

Number Originals Required:

Number Copies Required:

Required Return Date:

-- mm/dd/yy

Select how you want to receive this information:

Comments and instructions:

Please enter any comments, instructions or requests in space below (also explain any "other" selections made above):

Important: If this was a PURCHASE order, please email the contract to stout-manager@qwestoffice.net, or fax to 719-266-0728.