Address of Property: ______________________________________________________________

Parcel #: __________________________________ Improvement or Vacant? ___________________

Sellers Information:

Full Name: _______________________________________________________________________

Current Mailing Address: ____________________________________________________________

Home Phone: ___________________ Work 1: __________________ Work 2: _________________

Will seller be present for closing?    Yes    No

Marital Status: ____________ Sellers SSN: ___________________ Spouse's: ___________________

Attorney Information (if applicable): ________________________ Phone: _______________________

Payoff info:

Name of Payoff #1: __________________ Loan #: ______________ Phone: ____________________

Name of Payoff #2: __________________ Loan #: ______________ Phone: ____________________

Notes:___________________________________________________________________________

________________________________________________________________________________

If we need any additional information about the seller, Land Title needs to:

Buyers Information:

Full Name: ________________________________________________________________________

Current Mailing Address: _____________________________________________________________

Home Phone: ___________________ Work 1: __________________ Work 2: __________________

Will seller be present for closing?    Yes    No

Marital Status: ____________ Sellers SSN: ___________________ Spouse's: ___________________

Attorney Information (if applicable): ________________________ Phone: _______________________

Notes: ___________________________________________________________________________

_________________________________________________________________________________
 

If we need any additional information about the seller, Land Title needs to:

New Loan Information:

Lender: ______________________________        Loan Broker: ______________________________

Phone: _______________________________       Phone: ___________________________________

Contact: ______________________________       Contact: __________________________________

If Seller financed, need terms of mortgage:

Association Dues?    Yes    No                                               Rent Prorations?    Yes    No

Name/Contact: ___________________________                Amount of Rent: _________ Due: _______

Phone: ______________ Amount: ____________                Deposit Amount: ____________________

                                                                                              Held where? _______________________

Home Warranty?    Yes    No                                                 Other Prorations?     Yes    No

Name: __________________________________               Amount: _____________ Due: _________

                                                                                               Held where? _______________________

Is this a mobile home?    Yes    No

Who has the titles to mobile home? ______________________________________________________

Broker Information:

Listing Broker                                                                    Selling Broker

Office Name: ____________________________         Office Name: ___________________________

Agents Name: ___________________________          Agents Name: __________________________

Phone/FAX: _____________/_______________          Phone/FAX: _____________/_____________

Commission percent ____________ Listing percent ______________ Selling percent ______________

Deposit Amount: ________________________ being held by: ________________________________

Title Insurance Quote: _______________________________________________________________
 
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