Refinance Information Form

Refinance Information Form
Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
File Number, if available:
Owner/Borrower #1 Name:*
MarriedUnmarriedDivorcedWidow/Widower
Social Security/Tax ID#:*
Cell Phone:*
Home/Alternate Phone:
Email:*
example@example.com
Owner/Borrower #2 Name:
MarriedUnmarriedDivorcedWidow/Widower
Social Security/Tax ID#:
Cell Phone:
Home/Alternate Phone:
Email:
example@example.com
Current Address, if different from property address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
List all loans being paid off with this Refinance (Mortgages/Equity loans, etc.):
Payoff Lender 1 Name:
Payoff Lender 1 Phone Number:
Payoff Loan Number:
Payoff Lender 2 Name:
Payoff Lender 2 Phone Number:
Payoff Loan Number:
I/We do hereby authorize the release of any and all payoff inquiries to Briel PC Attorneys. If the loan is an Equity/Credit Line, please freeze the account upon issuing the payoff statement.
Signature:
Signature:
Signature*

Clear
Signature

Clear
Date Signed

MonthDayYear
Date
Should be Empty: