Property Street

Property City

Property State

Property Zip

Seller First Name

Seller Middle Initial

Seller Last Name

Seller SSN

Seller Cell Phone

Seller Work Phone

Seller Home Phone

Seller E-mail Address

Street Address after Closing

City after Closing

State after Closing

Zip after Closing

Choose a Marital status Single Married

Do you speak and understand English? (if not, please contact our office as soon as possible.) Yes No

Attending Closing? No Yes

Mail Away? No Yes

Will a Power of Attorney be used for executing documents? No Yes

If you answered “YES” to the Power of Attorney question, please contact our office as soon as possible.

Are you a U.S. Citizen? Yes No

If you answered “No” to the question, please contact our office as soon as possible.

Is the property address being sold your primary residence? Yes No

Is the property a mobile home? No Yes

Is there a divorce or bankruptcy that has not been discharged or recently discharged? No Yes

If you answered “YES” to the divorce or bankruptcy question, please contact our office as soon as possible.

Are there any Federal Tax Liens against the seller(s)? No Yes

If you answered “YES” to the Federal Tax Liens question, please contact our office as soon as possible.

If Title is held in the name of a Corporation, LLC, Partnership, Trust, or Estate, please contact our office as soon as possible.

Outstanding Mortgage/Payoff #1 Information

Lender Name

Lender Contact Name

Lender Contact Phone Number

Lender Contact Email Address

Lender Full Account Number

Outstanding Mortgage/Payoff #2 Information

Lender Name

Lender Contact Name

Lender Contact Phone Number

Lender Contact Email Address

Lender Full Account Number

Homeowners/Condo Association Information #1

Management Company

Contact Number

Homeowners/Condo Association Information #2

Management Company

Contact Number