Seller Information (VA) Form

Seller Information (VA Property) Form
Property Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
File Number, if available:
Seller #1 Name:*
MarriedUnmarriedDivorcedWidow/Widower
Social Security/Tax ID#:*
Cell Phone:*
Home/Alternate Phone:
Email:*
example@example.com
Seller #2 Name:
MarriedUnmarriedDivorcedWidow/Widower
Social Security/Tax ID#:
Cell Phone:
Home/Alternate Phone:
Email:
example@example.com
Owner OccupiedRental/InvestmentOther
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
Homeowners Association/Condominium Information (If applicable):
Association Name:
Association Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name:
Phone Number:
Date Dues Paid Through:

MonthDayYear
Date
Payment Amount:
NoYes
Payoff Lender Name 1:
Lender Phone Number:
Loan Number:
Payoff Lender Name 2:
Lender Phone Number:
Loan Number:
I/We do hereby authorize the release of any and all payoff and/or judgment/lien inquiries to Briel PC Attorneys. If the loan is an Equity/Credit Line, please freeze the account upon issuing the payoff statement.
Signature:
Signature*

Clear
Signature

Clear
Signature:
Date Signed

MonthDayYear
Date
Should be Empty:

Seller Information (VA Property) Form