Flood Application - New Account Setup

Account Information	Date: 7/4/2008 9:11:15 AM

Company name:
Phone:	Fax:
Address:
City:	State:
Zip:
Management Contact:
Phone:
Title:
E-mail:
Billing Address (P.O. Box):
City:	State:
Zip:
Billing Contact:
Phone:
Title:
E-mail:
Special Instructions:
For Lenders Only
Lender Identification #:
FDIC Insured: FDIC Insurance Cert. No., Credit Unions: Charter / Insurance No., Other lenders selling loans to Fannie Mae or Freddie Mac: Servicer No.

Real Estate Lending	1st Mortgage	Home Equity & 2nds	Commercial	Other RE	Total
# Portfolio Loans
Monthly New Loans

Request for Service
Flood Zone Determinations		Deliver FZD to:
	Life of Loan		Fax:
	Standard Determinations		E-mail:
Portfolio Flood Audit Compliance		Deliver Documents to:
	Flood Scan Review		Fax:
	Map Change Management		E-mail:
	Blanket Insurance Coverage for Portfolio
Flood Insurance		Deliver Documents to:
	Standard NFIP		Fax:
	Preferred Risk NFIP		E-mail:
	Excess Flood Ins. (up to $5 million)
	Forced Order Standard NFIP
	Forced Order Private - Domestic/Lloyds
	Flood Insurance Tracking Services