REFINANCE INFORMATION SHEET

Name*

First NameLast NameSuffix

Refinance of*

File Number*

Your Contact Information

The firm is authorized to communicate with you by:

1st Borrower Name*

First NameLast NameSuffix

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Marital Status*

Social Security Number*

Spouse Name

First NameLast NameSuffix

Your Preferred Method Communication (i.e. main contact, no email use, fax instead of email, etc.):

2nd Borrower Name (If Applicable)

First NameLast NameSuffix

Email

example@example.com

Phone Number

Please enter a valid phone number.

Marital Status*

Social Security Number*

Spouse Name

First NameLast NameSuffix

Your Preferred Method Communication (i.e. main contact, no email use, fax instead of email, etc.):

The Subject Property

Title to the property is current listed as:

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Will the title to the property be changing?*

YesNo

If yes, please write the new title information:

Is this property your primary residence (homestead)?*

YesNo

Mortgages

Do you have a mortgage on the subject property? If so, please complete the following and please also include equity line mortgages with no outstanding balance.

Lender

Loan Number

Lender Phone

Lender

Loan Number

Lender Phone

We authorize each of the foregoing lenders to communicate directly with Huy Jacob P.A. and to provide payoff and other related information. Further, we authorize any lender charges in providing this information.

Name

First NameLast NameSuffix

Name

First NameLast NameSuffix

Refinancing

Please provide the following:

Lender Name

Loan Officer or Contact Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Email

example@example.com

Delivery of Proceeds

If you are to receive any funds back, payment is to be made by:

Trust Account check made payable to SellerHeld for pick up,FedEx (Our firm charges a $30 fee for FedEx delivery)Wire Transfer (See Below)

FedEx Delivery Address (If Applicable)

Wire transfer (You must fill in all fields below for a wire transfer)

Contact your bank to confirm the proper wire routing/ABA number as
most banks have separate routing numbers for checks and wire transfers.

Bank Name

Routing/ABA Number

Bank Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Exact Name(s) on Your Account

Address On Account

Account Number

For Further Credit To

There may be a fee of $20-30 for wire transfers, depending on the closing agent, and your bank may charge anincoming wire fee.

Owner’s Title Insurance Policy

If you do not know what that is, please contact our office.

Do you have a title insurance policy?

I/We are attaching a copy of my/our owner’s title insurance policy.I/We cannot locate it.

Boundary Survey

Do you have a boundary survey? Note: this does not apply to most condominium units.

I/We are attaching a copy of my/our survey.I/We do not have a survey - I/We request a survey to be ordered on our behalf.

Document Execution

Where will you be for closing?

I/We are purchasing with cash and would like to sign remotely (available for locals and non-locals).I/We are purchasing with cash and would like to sign at your office in Naples.I/We are financing, will be in the area for closing and can sign in your office in Naples.I/We are financing, will not be in the area for closing, and request a “mail away” closing.

Ship closing documents to (If Applicable)

Post-Closing Information

If your address is different than the subject property, please provide your post-closing post office address.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Other

If there are any special circumstances that we should know about, please advise below:

If you have any questions or concerns while completing this form, please contact our office.

Our representation will consist of legal services required in an ordinary real estate
refinance: issuance of the title insurance commitment and policy; obtaining a copy of the existing title insurance policy and any surveys; processing the mortgage; preparation of the settlement (closing) statement; and completion of the actual closing. Our basic fees for these services will be $900.

Additionally, as agent for our title insurance underwriter, we will your lender’s title
insurance commitment and policy for a total premium of $0.00. This amount is the
mandatory premium amount set by the state of Florida and it is known as the promulgated rate. Your lender will likely require endorsements to their policy but the additional premium for the endorsements will not be known until we receive your lender’s policy requirements.

Further, in representing you, we will be incurring certain costs on your behalf (such costs may include application fees, title search, survey, and similar charges). These costs are necessary in order to protect your rights and interest, and to close the subject transaction. Should the closing not occur, while we will not charge for our work, you will be responsible for any costs advanced on your behalf.

Name*

First NameLast NameSuffix

Name

First NameLast NameSuffix