mgoeglein@earthlink.net
310-293-0784
Matt Goeglein
Sales Representative

Request a Farm
Ordering Party:
Company Name:
Address:
City State: Zip:
Phone #: Ext:
Fax #:
Contact Name: *
Email Address: *
Reference #:
OWNER INFORMATION
Name
Last Name
SUBJECT PROPERTY INFORMATION
Property Type:
Address:
City: State: Zip:
County:
LEGAL DESCRIPTION
Lot
Block:
Tract
Map Book:
Page:
Tax/APN:
Full Legal:
SERVICES REQUESTED
REPORT FORMAT:
6 Line
1 Line
Other: 		INCLUDE IN REPORT:
Owner Occupied
Absentee Owners

Area Sales Statistics (If Available)
Other:
LABEL FORMAT:
Site Address
Mail Address

Include:
Carrier Routes
Salutation
Owner Name from Data
Current Resident
 DATA FORMAT:
ACSII (Comma Delimited)
DBF
Tab Delimited

Other
(NOTE: All data provided on 3.5" disks unless otherwise requested.)
SORT RECORDS, LABELS OR DATA BY:
Owner's Last Name
Document Date
Land Use
Parcel Number
Price & Stamps
Site Address
Total Assessment
Mail CRT
Site CRT
Other: 		DELIVERY METHOD:
FAX
U.S. Mail
E-Mail 
Other:
SPECIAL INSTRUCTIONS
Any additional information or instructions:
Please Identify Your Sales Representative: *
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!