Date of Request_______________________ Sales Price of Property_________________

Type of Appraisal Requested____________ Type of Loan___________________________

Name of Buyer/Seller___________________________________________________________

Telephone of Buyer/Seller - Home_____________ Business___________ Other________

Address of Property____________________________________________________________

Location of Property___________________________________________________________

_______________________________________________________________________________

Recommendation for Access to Property__________________________________________

Name of Bank/Lender________________________ ___________________________________

Contact Person__________________ Telephone _______________ FAX_________________

Address of Bank/Lender_________________________________________________________

_______________________________________________________________________________

Name of Mortgage Company_______________________________________________________

Contact Person__________________ Telephone________________ FAX_________________

Address of Mortgage Company____________________________________________________

_______________________________________________________________________________

Data attached:    _______Contract _______Deed _______Tax Assessment

                   _______Other (______________________________________________)

Comparable Pictures Required: _____Yes _____ No Number of Originals___________

Comments:______________________________________________________________________

_______________________________________________________________________________