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Vendor Application

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Owner/Officer information

The name of the person or entity whose tax number you would enter on the W9. Example: Owner/CEO of an appraisal service, company president etc.

Name* ( first and last )

Title*

Telephone - Work*

Telephone - Mobile

Fax

Primary Contact Information

List the main contact person working with Landmarx Solutions

The contact information is the same as the owner info

Name* ( first and last )

Title*

Telephone - Work*

Telephone - Mobile

Fax

Company*

Mailing Address*

City*

State*

Zip*

Telephone #*

Fax #

Billing Information

The billing information is the same as the company info

Address 1

Address 2

City

State

Zip

Business Type - Select one from the list and enter it in the space provided. If .other., enter type.

Errors and Omissions Insurance Information

Does your company have Insurance?*
No Yes

If yes, who is your provider?

Enter the coverage limit

Appraiser Questionnaire

answer the following questions

1. How many years of residential appraisal experience do you have? Are you a trainee?*

2. Are you state licensed or certified? If you have a reciprocal license from another state, please disclose.*

3. Have you performed appraisals for HUD, relocation, or REO purposes?*

4. What % of your work over the last 2 years is REO or relocation work?*

5. Have you been removed from the Hud or VA panel?*

6. Do you or your company use trainees or staff less than 5 years of appraisal experience?*

7. What states do you appraise in?*

8. In what counties do you complete 70% of your appraisal work?*

9. Have you ever been convicted of a felony?*

10. Do you have any open complaints within the state or states you work in?*

11. Have you ever had any disciplinary action taken on your license?*

12. Are you currently an Appraisalport user?*

List professional organizations in which you hold membership.

* denotes required field