Closing Date:

MM

DD

YYYY

Property Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Buyer(s) Name(s): *

Please list full name and martial status of all new owners. If married, provide spouse’s name as a separate buyer*. Please clearly reference who is married to whom.

First Name

Last Name

Married: *

(If Yes, add spouses name as a buyer)

Yes

No

Buyer Name 2

First Name

Last Name

Married:

(If Yes, add spouses name as a buyer)

Yes

No

Buyer Name 3

First Name

Last Name

Married:

(If Yes, add spouses name as a buyer)

Yes

No

Buyer Name 4

First Name

Last Name

Married:

Yes

No

Phone *

(###)

###

####

Please provide your current mailing address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please provide your post-closing mailing address for mailing of Deed, tax bills, refunds, etc.:(do not write “same”) *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Lender Information (If paying cash, enter N/A): *

Name:

First Name

Last Name

Homeowner’s Insurance Information

Name:

First Name

Last Name

Phone

(###)

###

####

If the buyer/spouse is not attending the closing then a Power of Attorney (POA) is required (lender approval is necessary if there is a loan). *

Will the buyer need a POA?

Yes

No

Are you getting a survey of the property?*

Yes

No