Flood Zone Determination - $14
INCLUDES LIFE-OF-LOAN!
Flood
Compliance Services Request
Contact us at: 989.724.6622
Fax us at: 989.724.6676
CUSTOMER INFORMATION
Account Number:
32047
Requested by:
Inc.
Rush
(fee may apply)
Company Name:
Attention:
Address:
Telephone:
City, State, Zip Code:
Fax:
Telephone:
Email:
SERVICES REQUESTED
Contracted services are pre-coded
filler text here
Add:
Life-of-loan
HMDA
Multi-Lot
Re-certification
LOAN INFORMATION
Loan Type:
Check all that apply
Purchase
Refinance
Equity
Consumer: Last name, first(s)
Loan/Policy Number:
Loan/Policy Amount:
$
PROPERTY LOCATION INFORMATION
Provide standard USPS address
Individual
Business
Vacant Land
Type of structure:
Other Residential
Commercial
New Construction
Condo
Mobile Home
Apartment
Address Number and Street Name:
City:
State:
Zip Code:
County:
OPTIONAL INFORMATION
Year Built:
Industrial Park or Subdivision Name(s):
Parcel Number:
Lot Number:
Section:
Block:
Other Location Information:
The following is attached:
Legal Description
TRANSFER INFORMATION
New Mortgage Holder:
Telephone Number:
Mortgage Holder Address:
Contact:
New Loan Number:
FCSR03
February 2004