Borrower 1 Information

Name:

Email:

Phone:

Secondary Phone:

Marital Status:

Borrower 2 Information

Name:

Social Security #:

Email:

Phone:

Secondary Phone:

Marital Status:

Relationship & Title

Please fill out the fields below if there is more than one borrower.

Relationship:

Ownership Type:

Trust Information (if applicable)

Name of Trust:

Trust Tax ID or SS#:

Date of Trust:

Grantor of Trust:

Insurance Information

A new binder will be required reflecting your new Lender.

Agent:

Policy#:

Phone #:

We/I authorize Select Title & Settlement to obtain information regarding any homeowners insurance and to release completed copies of the HUD-1 Settlement Statement to the Realtors or attorneys representing parties in this transaction.

Condo Information (if applicable)

Association Name:

Association Phone:

Management Company:

Management Phone:

Authorization: We/I authorize Select Title & Settlement to receive any and all information with regard to our/my condo.

Other Information

Power of Attorney?:

Primary Residence?:

If not primary, please list primary address:

Spouse's legal Name:

Will Spouse be on the deed?:

Note: ALL Borrowers and spouses MUST attend the closing even if not listed as a borrower. Enter the legal name(s) for any spouse(s) not listed as a borrower.

Realtor Information

Buyer Agent Name:

Phone#:

Acknowledgements

I understand that any funds due must be by a Cashier's or Certified check payable to Select Title & Settlement.

I understand that all Borrowers and spouses must bring a photo ID to the closing.