2. The real estate offices of
4. and agent
6. Cell #
7. Office #
8. Email
10. Has been contacted by the (Select One)
    -- Select One --Owner of RecordAsset ManagerProperty ManagerLending InstitutionBanking Institution
12. Name of Owner of Record, Asset Manager, Property Manager, Lending Institution or Banking Institution as selected above:
14. Contact Name:
15. Phone #:
16. Email
18. For the sale of the foreclosed/real estate owned/short sale subject property located at:
20. Assessor's Parcel Number (APN):
22. And is requesting:

    1. Agent Information be kept on file and to be notified of any problems with the property
    2. Information regarding pending code violations
24. By filling in my name on this form, this shall act as my signature
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field