2400 E Commercial#1050
Fort Lauderdale, FL 33308
Fax: 970-797-1420
Email: orders@collateralmanagement.org
Credit Card / Account Debit Payment Authorization Form
I ___________________________________________________certify that I am an a uthorized s igner on the a ccount
below and authorize C ollateral M anagement L LC to char ge or debi t the acco unt for appraisal s ervices. I
understand that Collateral Management LLC is no t an affil iate of any mortgage company and all services
provided by Collateral Management LLC are completed upon electronic delivery of an appraisal completed
by a licensed appraiser to the mortgage company and when the appraisal is delivered, the services will have
been performed as agr eed r egardless i f the loan c loses or I a m d issatisfied wi th the value r eported. I al so
understand that if the charge is rejected I will be responsible for the debt and collection costs.
Furthermore, due to loan underwriting requirements, it may be necessary to complete additional appraisal
forms (such as Comparable Rental Schedule, Operating Income Statement, or Final Inspection) in the course of
this assignment. The fees for t he additional forms/se rvices range from $125 for Re nt Schedule to $150 for final
inspection. ________ (please initial)
I understand tha t a ny canc ellations may b e s ubject to a canc ellation f ee, base d on the a mount of w ork
performed a t the time o f c ancellation. T his fe e may range from a minim um of $3 5, t o a maxim um of th e
appraisal cost mentioned above.
Standard Appraisal Costs range from $425 to $750. A f ee will be confirmed once order has b een assigned to
the inspector in your area.
Please provid
e your email address so a copy of your appraisal can be sent to you.
Account Type: V
isa MasterCard AMEX Discover
Account Number:__________________________________________________________
Bil
l
i
ng / Accou
nt Address:____________________________________________________
City,
State, Zip:____________________________________________________________
Expi
ration Date:____________ CCV: (3 digit code located on the back of your card)
Amex is 4 digits on the front
Signature:________________________________________ Date: _______________________
Phone
:
_
_
____________________
Email to send appraisal:_ _____________ ____________________
Property Addre
ss:
Borrower
(
i
f
different than account holder)
_____
A facsimile or photocopy of this authorization is considered to be a legal binding contract.
*****We must receive this form in order to issue a copy of your appraisal. ****
