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Home
The Broker’s Difference
Broker’s Difference
Testimonials
Signature Cocktails
Quote Calculator
Forms
Buyer Form
Refinance Form
Seller Form
Contact
Resources
FAQs
Buyer Info
Seller Info
Privacy Disclosure
Buyer Form
Buyer Form
Please complete all information.
We will need the correct spelling of your name(s) and Social Security number(s). If the buyer is a corporation, partnership, limited liability company, or trust, please provide name of the entity and the Tax ID#. Please also forward us a copy of your trust.
Property Information
Property Being Purchased
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Buyer Information
How would you like your name(s) to appear on the deed?
Buyer Name
(Required)
Buyer SS# or TAX ID
If you prefer, you may call our office to provide your SS# /Tax ID#.
Buyer Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Cell Phone
Text Message Consent
By checking this box, you agree to receive SMS messages from Brokers Title and Closing.
Messages will be related to services. Message frequency will vary. You may reply STOP to opt-out at any time. Reply HELP for assistance. Messages and data rates may apply.
Email
Marital Status
Married/Married to Each Other
Married to Another
Unmarried
Separated
Widowed
Is there a second buyer?
(Required)
Yes
No
Buyer 2 Information
Buyer 2 Name
Buyer 2 SS# or TAX ID
If you prefer, you may call our office to provide your SS# /Tax ID#.
Buyer 2 Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Buyer 2 Cell Phone
Buyer 2 Cell Text Message Consent
By checking this box, you agree to receive SMS messages from Brokers Title and Closing.
Messages will be related to services. Message frequency will vary. You may reply STOP to opt-out at any time. Reply HELP for assistance. Messages and data rates may apply.
Buyer 2 Email
Buyer 2 Marital Status
Married/Married to Each Other
Married to Another
Unmarried
Separated
Widowed
Purchase Details
Title
(Required)
How would you like to hold title on the deed?
Joint Tenants with Right of Survivorship - An undivided interest in the property, taken by two or more joint tenants. The interest must be equal, accruing under the same conveyance, and beginning at the same time. Upon death of a joint tenant, the interest passes to the surviving joint tenant(s), rather than to the heirs of the deceased.
Tenants in Common - An estate or interest in land held by two or more persons, each having equal rights of possession and enjoyment, but without any right of succession by survivorship between the owners.
As an Individual - Ownership by an individual or entity legally capable of acquiring title.
Primary Residence?
(Required)
Will the property you are purchasing be your primary residence?
Yes
No
Borrower Attending Closing?
(Required)
Will you be in attendance at closing?
Yes
No
Borrower 2 Attending Closing?
Will borrower 2 be in attendance at closing?
Yes
No
Please call the office as soon as possible to discuss arrangements for your absence at closing.
Disclosures
Click below to download additional disclosure forms.
Non-representation Disclosure
Wire Fraud Disclosure
Preparing for Closing
Privacy Policy
Title Insurance Information
Affiliated Business Arrangement Disclosure
Disclosure of Non-Representation
(Required)
I acknowledge, confirm and understand the disclosure of non-representation.
Wire Fraud
(Required)
I have read the wire fraud disclosure and will call to verify or request changes to wire information.
Affiliated Business Arranagement Disclosure Statement
(Required)
I have read the affiliated business disclosure statement and understand that Berkshire Hathaway Home Services Verani is referring me/us to purchase the referenced settlement service(s) and may receive a financial or other benefit as the result of this referral..
Document Review Authorization
(Required)
At closing, I/We hereby authorize Broker's Title & Closing, LLC to review documents that may contain non-public information as follows (check one):
In the presence of parties related to my transaction, including but not limited to: real estate broker/agents; buyer(s); buyer's attorney or person representative(s); loan officers; title agency personnel; my personal representative(s)
In a private area
Document Distribution
(Required)
I/We authorize Broker's Title & Closing, LLC to distribute a copy of my/our ALTA Settlement Statement to real estate professionals involved in this transaction and my attorney (if applicable):
Yes
No
Signature
(Required)
Left click and drag your mouse to sign below.
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