CLIENT INFORMATION Contact's First Name Contact's Last Name Company Name Address Line 1 Address Line 2 City / State / Zip Office Phone () - Cell Phone () - Fax () - E-mail Address Type Report Requested Bill Client Or C.O.D.? Date Report Due Comments BORROWER(S) / PROPERTY INFORMATION Borrower's First Name Borrower's Middle Borrower's Last Name Co-Borrower's First Name Co-Borrower's Middle Co-Borrower's Last Name Property Address City/State/Zip County 1 - 2 -3 or 4 Family Dwelling Manufactured/Modular Home? Yes/No If Known, # BR's / BA's / Square Feet / Brief Description Of Property Borrower's Home Phone () - Borrower's Work Phone (If Can Be Contacted At Work) () - Co-Borrower's Work Phone (If Can Be Contacted At Work) () - Borrower's Cell Phone () - Co-Borrower's Cell Phone () - Purchase Transaction or Refinance? If Purchase, What Is Purchase Price? If Purchase, Realtor Or Seller's Phone () - If Purchase, Realtor's or Seller's Cell Phone () - Loan Amount & Loan-To-Value Other Pertinent Information Yarbrough And Company Your Professional Source For Real Estate Appraisal Services 852 High Street Macon, GA  31201 Office: (478) 745-2240     Fax: (478) 744-9526 ♦ Site Developed By The Holland Agency