Valucent Corp.

The order form below is intended for individual appraisal orders being placed by credit or debit card. Please have your credit or debit card ready, as well as basic property information, when placing order. If you are already a client of Valucent Corp., please go to}>Client Login screen to place order. If you are interested in becoming a frequent customer, need other payment arrangement, or are interested in our appraisal management services, please Contact Us.

	Are you an exsisting client or have you ordered an appraisal before with Valucent Corp.?*
	Yes No
	If you selected "yes" to the above, please go to the "Client Login" tab on this website.
	-CLIENT USER INFORMATION-
	Company Name:

	Client User Contact Name:*

	Client User Phone Number:*

	Client User Fax Number:

	Client User E-mail Address:*

	Appraisal Delivery E-mail Address (If different from above):

	Client User Title:

	Client User Address (Include unit or suite number if applicable):*

	Client User City:*

	Client User State:*

	Client User Zip Code:*

	-PROPERTY AND ASSIGNMENT INFORMATION-
	Purpose of Appraisal (ie; mortgage, probate, estate planning, divorce, pre-listing estimate, etc.):*

	If for Mortgage Lending, is this FHA?:
	Yes No
	If for Mortgage Lending, is Appraisal for Purchase or Refinance (If purchase, please note price):

	Borrower Name:

	Owner Name:

	Property Type (ie; single-family, Condominium, etc.):*

	Property Description:

	Property Address (Include unit number if applicable):*

	Property City:*

	Property State:*

	Property Zip Code:*

	Contact Name for Property Access:*

	Contact Phone Number:*

	Contact Alternate Phone Number(s):

	Special Instructions (ie; date of death for probate, need interior photos, etc.):

	-CREDIT OR DEBIT CARD PAYMENT INFORMATION-
	Card Type (Master Card, VISA, American Express, Discover, Diners Club):*

	Card Holder Name (exactly as on card):*

	Card Number:*

	Expiration Date:*

	Security Code/Panel Code: (3 digits on rear of most cards, 4 digits on front of Amex):*

	Card Holders Billing Address (Include unit or suite number if applicable):*

	Card Holders City:*

	Card Holders State:*

	Card Holders Zip Code:*

*Required fields

By clicking "Submit..." above you are authorizing charge(s) to your credit card for appraisal fee(s). Our basic fee schedule can be found by going to the Fee Schedule tab on this website. Unless otherwise noted in special instructions, appraisal will be completed on the most appropriate form considering assignment and property type. If, due to complexity of assignment (location or property characteristics), the fee is different from fee schedule you will be contacted prior to your order being processed.

For our refund, privacy and other policies, please go to the Policies tab on this website.

Thank you for trusting Valucent Corp. with your business!