CLIENT NAME ___________________________________________________________________________________
E-MAIL ________________________________________________________________________________________
CLIENT ADDRESS __________________________REFINANCE_____________________________________________________
CLIENT CITY ___________________________________________________ CLIENT ZIPCODE __________________
CLIENT STATE ________________ CLIENT PHONE _______________________ CLIENT FAX ____________________
SUBJECT ADDRESS ______________________________________________________________________________
CITY _________________________________________________________ COUNTY __________________________
(Check one of the following types)
PURCHASE ____________ __________ RELOCATION __________ COD ____________ BILL __________
PURCHASE PRICE __________________________________ ESTIMATED VALUE ______________________________
BORROWERS NAME ______________________________________________________________________________
SELLERS NAME _________________________________________________________________________________
ACCESS CONTACT _______________________________________________________________________________
PHONE # WORK ____________________________ HOME ______________________ CELL ____________________
FORM TYPE
FHA ____ FULL (1004) _______ CONDO ______ LAND _______ DRIVE BY 2070 ________
2055 ____ EXTERIOR ________ INTERIOR ________
MANUFACTURED HOME
PARK NAME _________________________________________________________ YEAR BUILT _________________
SERIAL NUMBER _________________________________________________ HUD DECAL _____________________
LENGTH ______________ WIDTH ____________ MAKE _______________________ MODEL ____________________
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