Primary Contact
*	Name
	Title
	Address
	City
	State
	Zip
*	Phone, Ext
	Fax
*	E-Mail
Secondary Contact
	Name
	Title
	Address
	City
	State
	Zip
	Phone, Ext
	Fax
	E-Mail

Draft reports are emailed to primary contact unless otherwise indicated.

Please select the format for submittal of final reports

Secure Electronic Download

2 bound hard copies

Electronic PDF file on CD

Both hard copy and CD

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General Property/Loan Information
	Purpose
*	Deal Name / Address of Property
*	Property Address
*	City
*	State
*	Zip
	Loan #
	Loan Amount	$
Loan Term / Reserve Table info (please choose one):
	10 + 2 = 12 5 + 2 = 7 7 + 2 = 9 15 + 2 = 17 Other
*	Loan term "Other" (please specify)
*	Property Description	# of Buildings, # of Floors, Rooms, SF, etc.
	Year Built
	Year Renovated
	Lot Size
		AcresSq Ft.
*	Building Size or No. Units
		Sq Ft.Units

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Property Contact Name
Company
Address
City
State
Zip
Phone
Fax
Email address
Relationship to deal

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Services/Proposals Requested
Phase I Environmental Site Assessment
None
Phase I ESA Standard Turnaround (15 business days)
Phase I ESA - Expedited Turnaround (14 business days or less)
No Phase I ESA NeededRequested Expedited Report Due Date: 

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Property Condition Survey
None
PCR - Standard Turnaround (15 business days)
PCR - Expedited Turnaround (14 business days or less)
No PCR NeededRequested Expedited Report Due Date:

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Seismic Probable Loss Study
None
Seismic PML Study - Standard Turnaround (15 business days)
Seismic PML Study - Expedited Turnaround (14 business days or less)
No Seismic PML Study Report NeededRequested Expedited Report Due Date:

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Desktop Review
None
Desktop Review - Standard Turnaround (7 business days)
Desktop Review - Expedited Review Turnaround (negotiable)
No Desktop Review NeededRequested Expedited Report Due Date:

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Preliminary Environmental Site Screening
None
Envionmental Site Screening - Standard Turnaround (7 business days)
Environmental Site Screening - Expedited Review Turnaround (negotiable)
No Environmental Site Screening NeededRequested Expedited Report Due Date:

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Regulatory Database Research
None
Standard Turnaround (7 business days)
Expedited Turnaround (negotiable) maybe additional cost
No Regulatory Database Research neededRequested Expedited Report Due Date:

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For multi-poperty portfolios, please resubmit an additional form for each property.

Files:
Please attach any relevant documents.

If this request is for a Phase I environmental site assessment or a property condition survey, and prior environmental reports are available, please attach copies. If electronic versions do not exist, please forward hard-copies to Client Account Coordinator, EBI Consulting, 21 B Street, Burlington, MA 01803.