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: