Please print this sheet and fax or mail back to us

Purchaser name(s):_______________________________________________

Seller name(s):___________________________________________________

Property address:_________________________________________________

Social Security # Name:_____________________ SS#____________________

                                 Name:_____________________ SS#____________________

Seller's marital status: (__) Husband & Wife (__) Single (__) Married

Home phone: ____________________  ____________________________

Work phone:  ____________________  ____________________________

Cell phone:    ____________________  ____________________________

Current Mortgage(s):
Lender #1: ___________________________________________________
Phone:        ___________________________________________________
Loan #:      ___________________________________________________

Lender #2: ___________________________________________________
Phone:        ___________________________________________________
Loan #:       ___________________________________________________

Homeowners Association/Condo Association (if any):
Management Co.: _____________________________________________
Phone:                  ______________________________________________

Well?  ____Yes  _____No       Septic?  ____Yes  ____No
Water/Sewer Company:
Name:     ___________________________________________________
Address: ___________________________________________________
Phone:    ___________________________________________________
Account #: __________________________________________________

Is a Power of Attorney needed at closing? (__) Yes (__) No
If so, who is the party granting P.O.A. ______________________________
Who will hold the P.O.A. _________________________________________

1031 Exchange?____Yes____No ( please provide copy of Exchange agreement)
Are you a Maryland Resident? ____Yes ____No
Non-MD-Resident have you applied for Certificate of Exemption? ____Yes____No

Any additional information such as seller paid closing cost credits note here:
__________________________________________________________________
__________________________________________________________________
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