Client Information
Date of Request:	* required
Name:	* required
Company:
Address:	* required
Phone:	* required
Loan Officer:
Email Address:
Borrower:
Property Information
Street Address:	* required
City, Zip Code	* required
Contact for Entry:	* required
Contact phone:	* required
Alternate phone:
Best Time to Call:
Purpose:	Purchase Refinance Other (Enter Comments)
Appraisal Type: (Choose all that apply)	Vacant Land 1004 Single Family 1004 SF FHA 1004C Manuf Home 1004C MH FHA 1004D Completion Cert 1004D Appraisal Update 1073 Condo 2055 Exterior Only Reverse Mortgage Rent Analysis Operating Income Statement Relocation Commercial Property Appraisal
Appraisal for:	Flagstar Bank Citicorp/Citibank Wachovia Landsafe Other (specify in comments)
Comments:

When choosing the type of appraisal be sure to select all items from the list that apply to your request.  Multiple items can be selected by holding the Ctrl key on your keyboard when making your selections.  When identifying the Purpose of your appraisal as "Other" explain the purpose for your appraisal in the Comment box.  You can also use the Comment box for additional explaination regarding you request. 

Thank you for using Carolina Certified Appraisals.  

P.O. Box 1097 * Skyland, NC * USA * 28776 * Phone: (888) 684-9478 Fax: (828) 684-9646