Refinance/Release of Lien Statement Request Credit Card

Requesting Company's Information
Name:
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia 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 West Virginia Wisconsin Wyoming
Zip:
Requestor's First Name:
Requestor's Last Name:
Escrow Number:
Phone:	- -  Ext.
Fax:	- -
Email:
Confirm Email:

Property Information
Association Name:
Property Address:
Owner's Name:

Documents (check all that apply)
		CC&Rs		Minutes
None		Bylaws & Articles of Inc.		Association Policies
		Financial Audit		Litigation Disclosure/Letter
		1365 Budget Package		Occupancy Report

Lender Questionnaire (check one if applicable)

Lender Form

Merit Property Management Form

By selecting Merit's form, in the event that the lender requires their own form to be completed, there will be a new charge for that request and that all the fees and turn around time on the lender's form will be considered a separate request

Turn Around Time

7 Business Day (no additional charge)

3 Business Day Rush (due the third business day after date received)

Next Business Day Rush (due the next business day after date received)

When ordering a Rush on a Statement AND a Lender Questionnaire, a rush fee will be charged for each

Delivery Options

Call for Pick-up (Orange County Area Only)

Fax/Email & Mail

FedEx   Account No:

UPS      Account No:

Call Other for Pick-up Name to Contact: Phone: - -  Ext.

Comments:

* Note: Not to be used for amending above information

Credit Card Information

Please contact: Name:  Phone:  -- Ext. We can accept Visa, MasterCard and American Express Cards only. There will be an additional $5 Service Charge for all credit card payments. Please be advised that in order to process the credit card we will need the Name on the card, Billing Address for the card, Card Number, Expiration Date and Security Code.