Appraisal Credit Card Authorization Form
Revised 02/21/2016
Loan Officer Name: ___________________________ Loan Number: _____________
First Name: __________________________
Middle Initial: ______
Last Name: __________________________ Phone Number: ___________________
Email Address: _________________________________________________________________
Street Number: _____________________ Street Name: _______________________________
City: ______________________________ Zip Code: ________________ State: __________
Credit Card Type: ____________________________
Payment Method: ____________________________ Expiration Date (MM/YY): ____________
Credit Card Number: __________________________ Card Verification Security Code: _______
[ ] Appraisal Form
[ ] Second Appraisal Form
[ ] Final Inspection
[ ] 1007
[ ] 216
[ ] Appraisal Update
Email appraisal request form to appraisals@prmg.net for price quote.
Should the loan fail to close, I understand the payment of this fee is still my responsibility.
Cardholder Signature Date
Amount: _____________
Forms Required
Amount: _____________
Amount: _____________
Amount: _____________
Amount: _____________
Amount: _____________
[ ] Broker Paid
Cardholder Information
Billing Address
By signing this form, I authorize Paramount Residential Mortgage Group, Inc. and Appraisal
Processing Corporation to order an appraisal and any additional appraisal documents for:
Borrower Name: ______________________________
Select One:
[ ] Borrower Paid