Contact Information

*Primary Phone Number

Fax Number

*Mailing Address

Mailing Address 2

*City

*State

*Zip Code

Property Information

*What State is the property located in?

*What County is the property located in?

*What is the property’s APN?:

What is the size of the property?

	Acres	OR
	SQ. FT.

Is there an HOA/POA in this area? If yes, what is your annual HOA/POA dues?

Are there any improvements on the property?:

House

Shed

Mobile Home

RV Hookup

Septic System

Well

Fence

Other:

Are there power lines to the property?

Does the property have Road Access?

How long have you owned your property?

Yrs

How did you acquire this property?:

What is your estimated value for the property?:

Is there anything else about the property that we should know about?

I verify that the form is complete and correct to the best of my knowledge.