STATUS REPORT - ORDER FORM

	Company name:
	From:
	Phone:
	Fax:
	Email:
	To:	Construction Credit Corporation
	Phone:	(206) 624-5877
	Fax:	(206) 624-7327

Please provide information on:

	Name:
	Address1:
	Address2:
	City:	State:    Zip:
	Name of Principal (if known):
	License Number (if known):