Collateral Evaluation Request

* means required

Today's Date:

Target Closing Date:

Branch/Client:*

Please select an item.

Loan Officer:*

Please select an item.

Loan Administrator:*

Please select an item.

Credit Officer:*

Please select an item.

Borrower's Name: *

Required.

County:

Collateral Property Address/Location:

Total Acres:

Existing or Proposed
Dwelling, Barns, Building, Fences, Wells, Pens, Pivots, Equipment, etc.:

Property Inspection:

Loan Officer will inspect has inspected will not inspect

Loan Amount:

Contract Sale Price:

Contacts for Inspection:

Name: *	Required.	Name
Phone: *	Required.	Phone:
Cell:		Cell:
Email:		Email:

Items that will be provided by Branch/Client:

Legal Description
Plat Map/Aerial Map/Topography Map/etc.
Survey Map
Copy of Contract
CRP Contracts/FSA Yield/Base (Form 156EZ)
Prior Appraisal
Construction Estimates/Specs (if applicable)

Other data available/Remarks or Special Instructions:

You must enter a value!

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equal housing

Equal Housing Lender
Equal Credit Opportunity Lender