Independent Apprasial Service INC.

Appraisal Order Form

	Your Information:  (* required fields) * First Name: * Last Name: Company: * Email: * Address: * City: * State: Alaska Arizona Arkansas California Colorado Connecticut Delaware DC Florida Georgia 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming * Zip Code: *Phone: Fax: (numbers only) Property Information: Address: City: State: New York Zip Code: County Erie Cattaraugus Chautauqua Genesee Monroe Niagara Orleans Wyoming   Appraisal Information: Purpose: Refinance Purchase PMI Removal Cash out Prelisting Other * (please specify in comment area) Purchase $: Purch. Date: Concessions: Owner Occ.: Yes No New Construction: Yes No Rush: Yes No Date Needed by: Comments: Payment: Borrower Seller Buyer Realtor Loan Officer Builder Check at Property Check mailed prior to Inspection        Property Contact Information (If different from above) Contact: Owner Borrower Realtor Builder Loan Officer Other ²   (please specify) First Name: Last Name: Phone: Home: Mobile: Email:
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