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** (call for pricing 541-504-0799 or email aaacon@aaahomeinspection.org ) Other Work Requested Payment Manufactured Home Fee Options (choose one): $425 - Certification paid at inspection$450 – Certification Paid by Credit Card$475 - Certification lender guaranteed billed to escrow Site Built/Modular Home Fee Options (choose one); $475.00 - Certification paid at inspection$500.00 - Certification Paid by Credit Card$550 - Certification lender 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: