BUYER Information Sheet

BUYER Information Form
Address of Purchased Property*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Will you be residing at the purchased property as your primary residence?*

YesNo
Closing date of this transaction*

MonthDayYear
1. Full Name(s) to appear on Title*

First NameLast Name
MaleFemale
Date of Birth*

MonthDayYear
Place of Employment*
Occupation*
2. Full Name(s) to appear on Title

First NameLast Name
MaleFemale
Date of Birth

MonthDayYear
Place of Employment
Occupation
Marital Status*
Number of years living together
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Forwarding Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone #’s
Cell*

Area CodePhone Number
Home*

Area CodePhone Number
Work

Area CodePhone Number
E-mail*
Title Information*
Are you a First Time Home Buyer*

YesNo
Mortgagee (Lender) Information

**Please ensure the mortgage lender is aware we are acting on your behalf and instructions are sent to our office at least 10 business days prior to closing**
Lender Name*
Address*
Tel. Number*

Area CodePhone Number
Fax. Number

Area CodePhone Number
Mortgage Broker*
Address*
Tel. Number*

Area CodePhone Number
Fax. Number

Area CodePhone Number
Will there be Bridge Financing? *

YesNo
Home Owners Insurance Information:

**Please ensure your agent faxes a binder letter to our office prior to closing**
Insurance Agent Name*
Policy No*
Company Name*
Company Address*
Tel. No*

Area CodePhone Number
Fax. No

Area CodePhone Number
Realtor Information
Real Estate Agent*
Company Name*
Company Address
Tel. No*

Area CodePhone Number
Fax. No

Area CodePhone Number
CLIENT CONSENT
*
Name/Names
hereby confirm that
a)         Green Germann Sakran has been asked to act for both or all parties involved in our purchase/sale/mortgage transaction;

b)         No information received, in connection with the matter, from one, can be treated as confidential so far as any of the others are concerned; and

c)         That, if a conflict develops, which cannot be resolved, Green Germann Sakran cannot continue to act for both or all parties and may have to withdraw completely.
Date*
City
MonthDayYear
Client Name*

First NameLast Name
Client Signature*
Client Name*

First NameLast Name
Client Signature*
Enter the message as it's shown*
Should be Empty:

CLIENT CONSENT