Refinance
Purchase
Construction Loan
Referring Company
Contact Name
Contact Phone
Contact Fax
Customer Name
Customer Name
Customer Phone
Alt Phone
Property Address
Property City, State, Zip
New Lender
Loan Amount
Back Title?
(within last 10 years)
yes
no
Prior Survey?
(within last 10 years)
yes
no
1.Lender being paid off
Account Number
2.Lender being paid off
Account Number
** PLEASE PROVIDE CUSTOMER AUTHORIZATION!
IF THIS IS A PURCHASE:
Seller's Name
Seller's Phone
Seller's Realtor
Seller's Phone
Buyer's Realtor
Buyer's Realtor Phone
Tentative Closing Date