Complete the form below and select the "Submit" button at the bottom of this page.
Requestor Information
Company Name
Requestor Name
Phone Number () - ext.
Fax Number () - Email address
Customer Information
Loan #
Customer Name
Property Address
City State -Select a state- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code
Occupancy Status -Select a status- Unknown Vacant Occupied
Provide phone numbers if appointments or direct contact with the customer is necessary:
Home Phone Number () - Work Phone Number () - ext.
Alternate Phone Number () - ext.
Services Requested
BPOs / Appraisals
BPO -Select a type- Drive-by (exterior only) Interior (includes exterior) If vacant, rekey 1 door, do interior, if occupied do drive-by If vacant, rekey all doors, do interior, if occupied do drive-by Rush -Select a type- No Yes - 72 hour Yes - 48 hour Yes - 24 hour Yes - same day
*Appraisal -Select a type- Drive-by (Form 2055) Interior (Full URAR) If vacant, rekey 1 door, do interior, if occupied do drive-by If vacant, rekey all doors, do interior, if occupied do drive-by
Number of Exterior Photos 0 1 2 3 4 5 6 7 8 9 10 Number of Interior Photos 0 All rooms 1 2 3 4 5 6 7 8 9 10
Comparable Photos -Select a type- No Yes Photo Delivery -Select a type- Regular mail Overnighted Emailed
* Rush appraisals will be completed as quickly as possible based upon the Appraiser's schedule.
Inspections
Delinquency Interview Occupancy Verification No Contact Inspection
Insurance Loss Home Improvement Other (Specify in "Comments" section below)
Rush -Select a type- No Yes - 72 hour Yes - 48 hour Yes - 24 hour Yes - same day Number of Exterior Photos 0 1 2 3 4 5 6 7 8 9 10 Number of Interior Photos 0 1 2 3 4 5 6 7 8 9 10
Photo Delivery -Select a type- Regular mail Overnighted Emailed
Property Preservation / Maintenance / Evictions
Locks Changed/Re-keyed -Select a type- Rekey one door Rekey all doors Cut Grass -Select- Once Weekly Bi-monthly Monthly Winterize
Board Broken Windows Eviction (Specify eviction details in "Comments" section below)
Comments:
Confidentiality Agreement:
Information submitted is considered Confidential Information and will remain the exclusive property of the Provider and will only be used by America's InfoMart, Inc. for the Permitted Purpose. America's InfoMart, Inc. will not use the Confidential Information for any purpose which might be directly or indirectly detrimental to the Provider or any of its affiliates or subsidiaries.
