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Buyer Information Request Form
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Laurie R. Stegall
Brian Clifford
Nick Canovai
Kermit Robinson
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Buyer Information Request Form
(Including Agent Authorization page)
"
*
" indicates required fields
Closing Date:
MM slash DD slash YYYY
Property Address:
*
Buyer(s) name(s): Please list full name and martial status of all new owners. If married, provide spouse’s name as a separate buyer*. Please clearly reference who is married to whom.
Full Legal Name or Corporate Name
(as shown on government-issued ID)
Male/Female
(optional)
Married:
(If Yes, add spouses name as a buyer)
Government issued identification
Full Legal Name or Corporate Name (as shown on government-issued ID):
Male/Female (optional)
Male
Female
Married: (If Yes, add spouses name as a buyer)
Yes
No
Upload Copy of ID
Max. file size: 10 MB.
Spouse's Name (as shown on government-issued ID):
Full Legal Name or Corporate Name (as shown on government-issued ID):
Male/Female (optional)
Male
Female
Married: (If Yes, add spouses name as a buyer)
Yes
No
Upload Copy of ID
Max. file size: 10 MB.
Spouse's Name (as shown on government-issued ID):
Full Legal Name or Corporate Name (as shown on government-issued ID):
Male/Female (optional)
Male
Female
Married: (If Yes, add spouses name as a buyer)
Yes
No
File
Max. file size: 10 MB.
Spouse's Name (as shown on government-issued ID):
Full Legal Name or Corporate Name (as shown on government-issued ID):
Male/Female (optional)
Male
Female
Married: (If Yes, add spouses name as a buyer)
Yes
No
File
Max. file size: 10 MB.
Spouse's Name (as shown on government-issued ID):
Spouses may be required to purchase real estate in the state of North Carolina. Please check with our office before assuming a spouse does not need to attend closing.
Best contact information for buyers:
Phone
Email
Please provide your current mailing address:
Please provide your post-closing mailing address for mailing of Deed, tax bills, refunds, etc.:(do not write “same”)
*
Lender Information (If paying cash, enter N/A):
Name:
*
Email
Homeowner’s Insurance Information:
Insurance Agent's Name:
Phone
Email
Policy Number:
If the buyer/spouse is not attending the closing then a Power of Attorney (POA) is required (lender approval is necessary if there is a loan).
Will the buyer need a POA?
Yes
No
If YES, then please call our office to discuss.
Are you getting a survey of the property?
*
Yes
No
If Yes, Should we order a survey for you?
*
Yes
No
If you are getting your own survey, please forward a copy of the survey, report and invoice to our office.
Drop files here or
Select files
Max. file size: 10 MB.
If you are getting your own survey, please forward a copy of the survey, report and invoice to our office.
Drop files here or
Select files
Max. file size: 10 MB.
Authorization of Release of Information To Be Signed by Buyer(s)
(Please Disregard if There is No Agent)
I/We
and
authorize Stegall & Clifford, PPLC to release and obtain necessary documentation and information throughout the closing process on the above-referenced property to my real estate agent
Agent Name:
of
Date Signed
MM slash DD slash YYYY
Signature 1
Signature 2
Printed Name 1
Printed Name 2
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