Your Name Company Phone Fax Email Address Type of Transaction ---Purchase CashPurchase LoanRefinanceEquity Credit Line Loan Estimated Closing Date Name of Seller/Owner Address City State: ALFLGA Zip: Will we need to ship documents? YesNo Name of Lender Lender's Phone Legal Description Address of Property City State: ALFLGA Zip: Tax Parcel # Surveyor Termite Inspector Home Owner's Warranty Mortgage Payoff Information: Lender to be paid Loan Number Lender Phone Number Δ