About You

    Name of person filling out form

    Borrower or Seller Info

    Name *

    Address:

    City/State/Zip:

    Home Phone:

    Cell Phone:

    Email*

    Realtor Information

    Buyer's Agent:

    Realtor Name:

    Phone:

    Email:

    Seller's Agent:

    Realtor Name:

    Phone:

    Email:

    Lender/Originator Information

    Company Name:

    Contact:

    Email:

    Company Address:

    Phone:

    Loan Information: *
    FHAVAUSDAReverseConventional, conforming (Fannie Mae/Freddie Mac)Conventional, non-conforming

    Home Info

    Home Type: *
    ManufacturedSite Built HomeModular Home

    Manufactured Home Size:
    Single WideDouble WideTriple Wide

    Property Address to be inspected: *

    Is the home...* VacantOccupied

    **Tie down installation available -- call for pricing.

    Other Work Requested

    Payment

    Manufactured Home Fee Options (choose one):
    $425 - Certification paid at inspection$450 - Certification lender guaranteed billed to escrow$495 - Certification not guaranteed & billed to escrow

    Site Built/Modular Home Fee Options (choose one);
    $475.00 - Certification paid at inspection$495.00 - Certification lender guaranteed billed to escrow$550.00 Certification not guaranteed & billed to escrow

    Will the invoice be paid out of escrow?*
    YesNo
    **If yes, lender guarantees payment. Please complete escrow information. Payment will be secured with credit card:

    Escrow Information

    Escrow Company:

    Escrow Contact:

    Escrow Co. Phone:

    Escrow Co. Email:

    Escrow #:

    Estimated Close Date:

    MISC. INFORMATION/SPECIAL INSTRUCTIONS: