By signing this form, I authorize Greenbox Loans, Inc. to order an appraisal for:
Borrower Name:
Co-Borrower Name:
Property Address:
CARD HOLDER INFORMATION:
Name on Card:
Billing Address:
Phone Number:
Email Address:
Payment Method (c
ircle one): VISA / MASTERCARD
Credit Card Number:
Expiration Date:
Security Code (back of card):
*
Appraisal Amount Not to Exceed: Refer
to state appraisal fee matrix. (Note: Should there be a need to order post appraisal forms i.e.
Score/1004 Final Inspection/Field or Desk Review/etc, any additional fee will be relayed to the Borrower before charging to the credit card
on file or may be collected prior to closing, payable to Greenbox Loans, Inc., 3250 Wilshire Blvd., Suite 1900, Los Angeles, CA 90010.)
Should the Loan fail to close, I understand that the payment of these fees is still my responsibility. I hereby authorize and approve Greenbox
Loans, Inc. to charge my credit card for the above mentioned fees or any other fees for this transaction.
_____________________________________________________ ________________________________ ___________________
PRINT NAME
SIGNATURE DATE
Updated 1/31/2018
FAX COMPLETED FORM TO (213) 235-4326
AUTHORIZATION FORM
For Appraisal Orders
With the understanding that Greenbox Loans, Inc. will not collect any money for appraisal or order the appraisal until I have acknowledged in
writing my "Intent to Proceed with Loan Application".
Contact for Purchase:
click to sign
signature
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