Document & Certificate of Assessment Request Form

Requestor Type

Homeowner Name

First NameLast Name

Lender Name

Attorney Name

Other, please provide:

Property Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

New Construction Home?

COA Recipient Name

First NameLast Name

COA Recipient Email Address

example@jotform.com

Additional Recipient Email Addresses

Separate email addresses with a comma

Proposed Closing Date

Date

Services Requested

Additional Notes or Instructions

Certificate of Assessment (COA)

$95.00 Quantity

BURROUGHS AT CAROLINA PLANTATIONS RESIDENTS ONLY - Certificate of Assessment (COA)

Select this option to request a COA covering both Burroughs OA and Carolina Plantations OA.

$190.00 Quantity

Certificate of Assessment (COA) Rush Fee

$100.00 Quantity

Lender Questionnaire

$150.00 Quantity

Document Request

$95.00 Quantity

Total