Real Estate Law and Estate Planning Law
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Buyer Information Request Form
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Refinance – Information Request Form
Seller Information Request Form
Sellers/Listing Agent Request Form
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Laurie R. Stegall
Brian Clifford
Robert W. Brown III
Kermit Robinson
Nick Canovai
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Refinance – Information Request Form
Closing Date:
MM slash DD slash YYYY
Property Address:
Owner(s) name(s): Please list full name and marital status of all property owners. **If married provide spouse’s name as a separate owner** Use additional sheets if necessary. Reference who is married to whom.
Full Legal/Corporate Name (as shown on government-issued ID):
Sex:
M
F
Married:
Yes
No
Full Social Security Number/Full Tax ID Number***
Spouse's Name (as shown on government-issued ID):
Full Social Security Number/Full Tax ID Number***
Full Legal/Corporate Name (as shown on government-issued ID):
Sex:
M
F
Married:
Yes
No
Full Social Security Number/Full Tax ID Number***
Spouse's Name (as shown on government-issued ID):
Full Social Security Number/Full Tax ID Number***
Full Legal/Corporate Name (as shown on government-issued ID):
Sex:
M
F
Married:
Yes
No
Full Social Security Number/Full Tax ID Number***
Spouse's Name (as shown on government-issued ID):
Full Social Security Number/Full Tax ID Number***
**Spouses are required to sell real estate in NC. ***Required for 1099 filing with IRS.
Best contact information for owners:
Phone
Email
Is the property being sold your current primary residence?
Yes
No
Post-Closing Mailing Address:
(for return of documents, refunds, etc.)
How would you like to receive closing proceeds?
Pick–Up (no charge)
UPS ($50 fee-see below)
Wire ($50 fee-see below)
***In order to send a wire, we must have an ORIGINAL voided check, or wire instructions from an attorney’s trust account. If you do not have a physical check to provide, please ask for a Wire Authorization Form, though it will need to be notarized. We are unable to send a UPS to a PO Box.
Current Liens & Mortgages (Payoff Information)
Name of Mortgage or Equity Lender
Full Loan
Current Balance Estimate ($)
Contact Phone #
Mortgage or Equity Lender
Full Loan
Current Balance Estimate ($)
Contact Phone #
Mortgage or Equity Lender
Full Loan
Current Balance Estimate ($)
Contact Phone #
Mortgage or Equity Lender
Full Loan
Current Balance Estimate ($)
Contact Phone #
-Typically, written payoffs will be provided by your lender. We will use the information provided above order any necessary documentation if they are unable to provide a payoff to us.
-Provide information for all Mortgage/Equity Lines even if they have a $0.00 balance.
-Stegall & Clifford will order your payoff statement. We will charge $50 per loan to overnight the funds to your mortgagor.
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