Wertz Construction Request Form – NAFHAC

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443-253-5428

Independent Consultation Request Form

Attention: This form must be completed by a loan officer/mortgage processor ONLY.

Please complete this form in order for the process of providing renovation consultation services to formally begin (as per HUD guideline).
Please note field marked with a red * are mandatory.
Please hit the submit button at the bottom when completed. Once received, you will receive a confirmation email and will be included in all email communication with your client/borrower.
Any questions, please call our office and ask for Rehab Project Coordinator.

Mortgage Company:

Mortgage Specialist/Officer:

Office #

Mortgage Specialist Email:

Cell Phone #

Borrower Name/s:

Borrower Email:

Current Home Address

Street Address:

City:

Zip:

State

Home Phone No:

Cell Phone:

Subject Property Address

Street Address:

City:

Zip:

State

# of Units:

Owner Occupied/Investor

Type of Financing

Estimated Loan/Purchase Amount:

Maximum Loan Amount:

Estimated Rehab Amount:

Date Plan Ordered:

Date Plan needed by:

Settlement Date:

Loan #

Comments:

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