Borrower 1 Information

Name:

Email:

Phone:

Secondary Phone:

Marital Status:

Borrower 2 Information

Name:

Social Security #:

Email:

Phone:

Secondary Phone:

Marital Status:

Relationship of Sellers:

Trust Information (if applicable)

Name of Trust:

Trust Tax ID or SS#:

Date of Trust:

Grantor of Trust:

Mortgage Information

Please list all current Mortgages/Home Equity Lines pertinent to this property including loans with a zero dollar balance.

Mortgage Company1 Name:

Phone#:

Account#:

FHA Mortgage: YesNo

Pre-payment Penalty?: YesNo

Mortgage Company2 Name:

Phone#:

Account#:

FHA Mortgage: YesNo

Pre-payment Penalty?: YesNo

Other Mortgages:

Please enter details for any other mortgages related to this property.
NOTE: It is your responsibility to cancel any automatic payments or withdrawals (if applicable).

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.

Other Information

Power of Attorney?:

Primary Residence?:

If not primary, please list primary address:

Tax Information:

Tax Bill Copies:

Spouse's Legal Name:

Note: ALL Sellers 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 an owner.

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 Sellers and spouses must bring a photo ID to the closing.