BUYER INFORMATION SHEET
Please type or print on form
Full name(s) and Date of Birth of Buyer(s). Please indicate
names as you wish same to appear on the Deed.
Buyer 1’s
name
Buyer
1’s DOB
Buyer 2’s name
Buyer 2’s DOB
Buyer 1’s Social Security Number
Buyer 1’s DLN#
Buyer 2’s Social Security Number
Buyer 2’s DLN#
Buyer
1’s present address:
Buyer 2’s present address: ( If same as Buyer 1 just fill in “same as above”)
Maiden Name of Wife:
Date of Marriage:
Home telephone number: ( )
Work telephone numbers: ( ) (
)
Cell phone numbers: ( )
( )
E-Mail: Fax: ( )
E-Mail:
MORTGAGE INFORMATION
Desired Closing Date:
Estimate Move-in Date:
Name, address and telephone number of Lender for proposed mortgage loan:
Name
of Mortgage Processor:
MARITAL HISTORYHusband
Formerly married to:
How marriage terminated:
Date marriage terminated:
Wife
Formerly married to:
How marriage terminated:
Date marriage terminated:
Is the property you are purchasing
in a homeowner’s association or community association? If yes, please provide name address and telephone
number of same.
Have either Buyer 1 or Buyer 2 ever declared Bankruptcy. If, yes
please provide date of discharge, type of Bankruptcy Chapter filed, Court filed in and docket number.
Child Support: Please
indicate if any judgments for the payment of child support exist with reference to either Buyer 1 or Buyer 2.
Indicate if any judgments have been obtained against Buyer 1 or Buyer 2.
Survey
data: You must confirm in writing if you will require corner staking of the property being purchased.
The survey customarily costs approximately $575.00- $750.00(under one acre); with an additional
cost of $75.00 per stake for each corner stake. Kindly complete the following and sign indicating whether
or not property is to be staked.
_____
I do require property corner stakes set by surveyor.
______ I do not require property corner stakes set by surveyor.
Dated: _____________
__________________________________________
Buyer 1
Dated:
_____________
__________________________________________
Buyer 2