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YOUR INFORMATION Ordering Party : * --Select an Ordering Party-- Real Estate Agent/Broker Mortgage Broker Lender Attorney Government Company Name: Address: City: State --Select a State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C West Virginia Wisconsin Wyoming Zip: Phone: (  )  -  ext Fax: (  )  -  ext Contact Name: * Email Address: * Reference #: OWNER INFORMATION Name: Name: SUBJECT PROPERTY INFORMATION  Property Type: --Select a Property Type-- Residential(SFR) Residential(Condo) Commercial Land PUD Other If Other, please describe:  Address: City: State: --Select a state-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C West Virginia Wisconsin Wyoming Zip: County: LEGAL DESCRIPTION   Lot: Block: Tract: Map Book: Page: Tax/APN: Full Legal Description: SERVICES REQUESTED Report Format : Include in Report : 6 Line Owner Occupied 1 Line Absentee Owners Other: Only Records w/ Phones Area Sales Statistics (If Available) Other: Label Format : Data Format : Site Address ASCII (Comma Delimited) Mail Address DBF Include: Tab Delimited Carrier Routes Other: Salutation (NOTE: All data provided on 3.5" disks unless otherwise requested.) Owner Name from Data Current Resident Bar Code Sort Records, Labels or Data By : Delivery Method : Owner's Last Name FAX Document Date Courier (Where Available) Land Use Sales Rep to Deliver Parcel Number U.S. Mail Price & Stamps E-Mail Site Address Other: Total Assessment Mail CRT Site CRT Other: SPECIAL INSTRUCTIONS Any additional information or instructions:  Please Identify Your Fidelity Sales Representative:* --Select a Sales Rep-- Bridgette Nelson Jody Ballard Please press Submit button one time only. If you experience any difficulty with this online form, please contact your Fidelity representative for assistance. Thank you!