Settlement Date*
Seller(s)(Maximum 100 characters)
Phone Number*
Email ID *
Buyer(s)(Maximum 100 characters)*
Property Address*
Forwarding Address*
Seller 1 Social Security #
Seller 2 Social Security #
Seller1 is a

Seller2 is a

Seller1 Current Martial Status

Seller2 Current Martial Status

Seller’s Lender Name 1st Trust:*
Loan Number:*
Phone Number*
Date of last 1st mortgage payment and date seller plans to make the next payment :
Seller’s Lender Name 2nd Trust: (If applicable)
Loan Number:
Phone Number
Date of last 2nd mortgage payment and date seller plans to make the next payment :
Listing agent’s Name :*
Phone Number*
Email ID *
Name and Address of the Listing Agent’s Company :*
Home Owner’s Association Name: *
Phone Number*
Contact Person *
Date of last HOA payment and date seller plans to make the next payment :
Termite Inspection Company: *
Phone Number*
Home Warranty : Yes / No*
Warranty Provider:*
Paid By:
Cost:
Disbursement Of Funds
Mail Check to: *
Wire Funds to Account # *

If you would like the funds wired, please bring a copy of the voided check to settlement.

Routing #*
Additional Information
Power Of Attorney Needed? Yes / No
Are there any charges/credits to the Purchaser?
Is there any Pre-occupancy or Post-occupancy (Rent Back)? Yes / No

(if Yes please send copy of appropriate Agreement to escrow@loudountitle.com)


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Open Hours

Monday - Friday :
9:00AM - 6:00PM

Closed on Saturday and Sunday