Borrower or Seller Info

Name *
[text* your-name]

Address:
[text Address]

City/State/Zip:
[text City-State-Zip]

Home Phone:
[tel HomePhone]

Cell Phone:
[tel CellPhone]

Email*
[email* your-email]

Realtor Information

Realtor Name:

[text realtor]

Buyer’s Agent:

Buyer’s Name:

[text buyername]

Phone:

[tel realtor-phone]

Email:

[email realtor-email]

Seller’s Agent:

Realtor Name:

[text realtor2]

Phone:

[tel realtor-phone2]

Email:

[email realtor-email2]

Lender/Originator Information

Company Name:
[text companyname]

Contact:
[text companycontact]

Email:
[email lender-email]

Company Address:
[text companyaddress]

Phone:
[tel companyPhone]

Loan Information:
[checkbox loan-information “FHA” “VA” “USDA” “Reverse” “Conventional, conforming (Fannie Mae/Freddie Mac)” “Conventional, non-conforming”]

Home Info

Home Type:
[radio hometype “Manufactured” “Site Built Home” “Modular Home”]

Manufactured Home Size:
[radio mfrHomeSize “Single Wide” “Double Wide” “Triple Wide”]

Property Address to be inspected:
[text propaddress]

**Tie down installation available — call for pricing.
Payment

Manufactured Home Fee Options (choose one):
[radio HomeFee “$425 – Certification paid at inspection | 425.00” “$450 – Certification lender guaranteed billed to escrow | 450.00” “$495 – Certification not guaranteed & billed to escrow | 495.00”]

Site Built/Modular Home Fee Options (choose one);
[radio HomeFee “$475.00 – Certification paid at inspection | 475.00″ ” $495.00 – Certification lender guaranteed billed to escrow | 495.00″ ” $550.00 Certification not guaranteed & billed to escrow | 550.00″]

Will the invoice be paid out of escrow?
[radio paidEscrow “Yes” “No”]
**If yes, lender guarantees payment. Please complete escrow information. Payment will be secured with credit card:

Escrow Information

Escrow Company:
[text escrowCompany]

Escrow Contact:
[text EscrowContact]

Escrow Co. Phone:
[tel EscrowCo.Phone:]

Escrow Co. Email:
[email escrowemail]

Escrow #:
[text EscrowNo]

Estimated Close Date:
[text EstimatedCloseDate]

MISC. INFORMATION/SPECIAL INSTRUCTIONS:
[textarea miscInstructions]

[recaptcha]

[submit “Submit”]