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Affiliates
* Required Field        
*Contact Name *Referral Source
*Company Number of appraisers? Licensed:

Certified:
*Address        
*City *State *Zip
*Email This is the address to which we will send all new orders, status requests and any other communication.
*Fax        
*Office Phone        
*Home Phone        
*Cellular Phone          
*E&O Insurance        
*Software If other, please specify:
*XML Capable? Yes   No THIS IS REQUIRED TO WORK WITH FLS
     
IF you do not currently have this, you must be willing to obtain it.
         

License Information

    
*State *Type *Number
*Expiration        
State Type Number
Expiration        
*FHA Approved Yes No        
       
1. Do you have experience with high value/complex properties? Yes No
2. Do you have experience with REO work? Yes No
Please provide brief description of experience:
Have you ever had any Real Estate License suspended, restricted or revoked? Yes No
If yes, provide details:
Have you ever been convicted of a felony, misdemeanor or any public offense having as one of its elements a fraudulent or dishonest act? Yes No
     

Coverage Area

    
*Please provide state and county
Please provide at least three business references
Name:
Phone:
The foregoing application has been completed by me to induce Fiserv Lending Solutions to approve me as a Fiserv Lending Solutions Affiliate. I hereby certify that the answers and statements made are true and correct to the best of my knowledge and belief. In connection with my application, I understand that my references will be contacted. If approved to become part of the FLS Affiliate Network, I understand it is my responsibility to promptly update FLS Vendor Management with any change to the foregoing.
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