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Custom Farm Request

Disclaimer: This site is not designed for the transmission of highly confidential customer, non-public personal information, and should therefore not be used to enter or transmit data such as customer Social Security Numbers or Driver's License Numbers.

Please complete fields appropriate to your order. Do not press ENTER until end - use TAB to advance to next field.

Please press submit button one time only. If you experience any difficulty with this online form, please contact your Fidelity representative for assistance. Thank you!

Fields marked with * are mandatory.
YOUR INFORMATION
* Ordering Party:
* Company Name:
* Address:
* City:
* State:
* Zip:
Phone #: ext
Fax #: ext
* Contact Name:
* Email Address:
* Confirm Email Address:
Reference #:
OWNER INFORMATION
Name:
Name:
SUBJECT PROPERTY INFORMATION
Property Type:
Address:
City:
State:
Zip:
County:
LEGAL DESCRIPTION
Lot:
Block:
Tract:
Map Book:
Page:
Tax/APN:
Full Legal Description:
SERVICES REQUESTED
REPORT FORMAT:

(Required if Other is selected)
          
INCLUDE IN REPORT:



(Required if Other is selected)
        
LABEL FORMAT:
Include:



DATA FORMAT:



(Required if Other is selected)
          
(NOTE: All data provided on 3.5" disks unless otherwise requested)
SORT RECORDS, LABELS OR DATA BY:








(Required if Other is selected)
DELIVERY METHOD:




(Required if Other is selected)
      
SPECIAL INSTRUCTIONS
Any additional information or instructions:
Please Identify Your Sales Representative: