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Please complete this form, print it, and return it with your check to the Property Valuation Administrator, 34 S. Main Street, Winchester, KY 40391.
First Name:
Last Name:
Company Name:
Address:
City:
State:
Zip Code:
Email Address:
When requesting a username and password, you must use lowercase letters only. No numbers or other punctuation will be accepted. All usernames and passwords MUST be at least six letters long.
Requested Username:
Requested Password:
	Number of Records. Check one.    10 Records per month for 12 months - $100    25 Records per month for 12 months - $200    50 Records per month for 12 months - $400    100 Records per month for 12 months - $750