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Home
The Broker’s Difference
Testimonials
Quote Calculator
Forms
Buyer Form
Seller Form
Contact
Resources
Buyer Info
Seller Info
Privacy Disclosure
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Refiance Form
Refiance 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 Refinanced
(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
Borrower 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.
Borrower Name
(Required)
Borrower SS# or TAX ID
If you prefer, you may call our office to provide this information.
Borrower 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
Email
Marital Status
Married/Married to Each Other
Married to Another
Unmarried
Separated
Widowed
Is there a second borrower?
(Required)
Yes
No
Borrower 2 Information
Borrower 2 Name
Borrower 2 SS# or TAX ID
If you prefer, you may call our office to provide this information.
Borrower 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
Borrower 2 Cell Phone
Borrower 2 Email
Borrower 2 Marital Status
Married/Married to Each Other
Married to Another
Unmarried
Separated
Widowed
Closing Info
Is this Homestead Property (your primary residence)?
(Required)
Yes
No
Borrower(s) Attending Closing?
(Required)
Will all parties on title (including spouse to release homestead) be attending this closing?
Yes
No
Property Info
Property Type
(Required)
Single Family
Condo
Multi-family
Mobile Home
Land
Other
Condo or PUD?
(Required)
Is your property in a condominium or planned unit development association?
Yes
No
Condo/PUD Contact
(Required)
Provide the contact name and telephone# for the association.
Mobile Home Park?
(Required)
Is your property located within a Mobile Home Park?
Yes
No
Park Contact
(Required)
Provide the contact name and telephone# for the mobile home park.
Property Taxes Paid to Date?
(Required)
If you have an outstanding tax bill and pay it prior to closing, please notify us of your intention and bring the paid receipt to closing.
Yes
No
Mortgages
How many mortgages and/or Home Equity Lines of Credit (HELOC) do you have?
none
1
2
3
Lender 1
Lender 1 Account#
Lender 1 Phone
Lender 1 Last Payment Date
MM slash DD slash YYYY
Lender 2
Lender 2 Account#
Lender 2 Phone
Lender 2 Last Payment Date
MM slash DD slash YYYY
Lender 3
Lender 3 Account#
Lender 3 Phone
Lender 3 Last Payment Date
MM slash DD slash YYYY
Consent & Disclosures
Click below to download additional disclosure forms.
Non-representation Disclosure
Wire Fraud Disclosure
Preparing for Closing
Privacy Policy
Affiliated Business Arrangement Disclosure
Consent to Obtain Payoffs
I/We authorize the release of payoff information for the above-referenced mortgage(s).
In the event this loan is secured by a Mortgage allowing for advances of a credit line, please be advised that this letter authorizes you to freeze the referenced credit line upon issuance of your payoff. If you require further authorization, please contact the undersigned immediately. Payment pursuant to your payoff will eliminate any security interest your have in the property in question. In order to avoid unsecured additional advances, the account must be frozen upon issuance of your payoff. If you make any additional advances, they will not be secured by the subject property. We will be completing an escrow/ closing transaction involving a new owner or lender in reliance on the release of your security interest in the property. Upon payment you will be obligated to issue a release of the Mortgage securing the line of credit.
I/We authorize the release of payoff information for the above-referenced mortgage(s) and to freeze advances on lines of credit (if applicable)
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..
Signature
(Required)
Left click and drag your mouse to sign below.
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