Seller Information (WV) Form

Seller Information (WV Property) Form
Property Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
File Number, if available:
Seller #1 Name:*
Marital Status:

MarriedUnmarriedDivorcedWidow/Widower
Social Security/Tax ID#:*
Cell Phone:*
Home/Alternate Phone:
Email:*
example@example.com
Seller #2 Name:
Marital Status:

MarriedUnmarriedDivorcedWidow/Widower
Social Security/Tax ID#:
Cell Phone:
Home/Alternate Phone:
Email:
example@example.com
Is the subject property:*

Owner OccupiedRental/Investment
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:
Do you have any payoffs (Mortgage/Equity, etc.)?*

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 Seller 1*

Clear
Signature:
Signature Seller 2

Clear
Date Signed*

MonthDayYear
Date
Should be Empty:

Seller Information (WV Property) Form