Regulations pertaining to credit card purchases require Cutler Appraisal Services to obtain the following information in order to process any credit card purchases without physical possession of the card and the embedded information on the magnetic strip.  Please fill out this form completely to assure prompt order processing. 

Fax to 877-834-1322.

Required Fields       Optional Fields                     

Order Number:	_______________________________________
Invoice Number:	___________________________________________
Subject Address:	___________________________________________
Subject City, Zip:	___________________________________________
Mortgage Company:	___________________________________________
Loan Officer/Broker:	___________________________________________
Order Total*:	___________________________________________
Credit Card Type:	________________________________(MC, Visa, Discover)
Cardholder Name:	___________________________________________
Billing Address:	___________________________________________
City, State, Zip:	___________________________________________
Home Phone:	___________________________________________
Office Phone:	___________________________________________
Cell Phone:	___________________________________________
Fax Number:	___________________________________________
Credit Card Number:	___________________________________________
Expiration Date:	___________________________________________
CCV Code  :	___________________________________________
(3 or 4 digit code on back of card)

I authorize Cutler Appraisal Services to charge my credit card without any misunderstanding of misuse at any time.  I also agree that the billing address above is valid and that I am an authorized card holder for the above credit card account.

___________________________________________                         ______________________________

Card Holder's Signature                                                                     Date

 * Be advised that any appraisal paid via credit card is subject to $25.00 surcharge.  This surcharge is NOT included on any fee schedule.  Please anticipate this additional charge before choosing the credit card payment option.

Because of the manner in which credit card payments are processed, the charged amount will not show as received by Cutler Appraisal Services for 1-3 days.  Company policy does not permit the appraisal to take place until the funds are shown as received.  We will, however, schedule the appraisal time and date.  Cutler Appraisal Services reserves the right to reschedule or cancel the appraisal in the event of non-payment.