APPRAISAL REQUEST ORDER FORM

Requested By: At: Phone Fax: Email Lender Address City, State, Zip Phone Fax: Email Please put report in lender name Borrower/Owner Borrower/Buyer Subject Property City/Zip Code Home Phone Work Phone: Broker / Agent Phone Additional Comments/ Legal Fee Amount(See Fee Schedule) Bill Collect Credit Card N/A Visa MasterCard Discover American Express Name On Card Account Number Expiration Date: Purchase Price/ Value Return Delivery Instructions Priority Mail Overnight Bill Local Delivery Will Pick Up For Overnight Delivery - Account # and Company Name PLEASE NOTE THAT YOUR COMPANY'S NAME WILL BE LISTED AS LENDER ON THE REPORT UNLESS YOU STATE OTHERWISE. ALSO, LET US KNOW WHERE WE SHOULD SEND THE REPORT UPON COMPLETION (PLEASE NOTE THAT WE WILL CHARGE AN ADDITIONAL $25 OVERNIGHT FEE IF YOU WANT US TO OVERNIGHT THE REPORT OURSELVES). 213 NORTH MILLS AVENUE - ORLANDO, FLORIDA 32801 PHONE (407) 896-7714 - FAX (407) 896-7378 appraisers@torkos.com