Evidence of Insurance Request from Kay Pacey Insurance Services

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Lender's Request for Evidence of Insurance

Call Toll-Free 1-866-616-0571

Please provide the following loan information prior to sending:

Your Name

Your E-mail Address

Your Company

Your Phone #

Your Fax #

Vesting

Property Address

1^st Mortgagee

Loan#

Loan Amount

2^nd Mortgagee

Loan#

Loan Amount

Effective Date

Impound

Roof Type

Deductible not to exceed $1,000.00

Policy needs to have 6 months coverage. If not, please send a bill.

Comment/Question

^{NOTE: 2,000 character limit.}

Please fax the first page of the loan application to 707-224-5663 showing the following information for the applicant(s):

(1) Date of birth
(2) Social Security number
(3) Employment information.