About You

Borrower 1*

Borrower 2*

Email*

Please leave this field empty.

Best phone number to reach you*

Marital Status*

MarriedSingle

Primary Residence?*

YesNo

Borrower 1 SSN*

Borrower 2 SSN*

Borrower 2 Relationship to Borrower 1

About Your Homeowner's Insurance

Insurance Company

Agent's Phone*

Expiration Date

Annual Premium

If you do not have the insurance information available at this time, please provide it as soon as possible. (This applies to condominiums as well.)

Owners Currently listed on deed

Current Mortgage Information

Lending Institution (1st Mortgage)

Equity Line/ Second Mortgage

Lending Institution (2nd Mortgage)

Will the 2nd mortgage be?

SubordinatedPaid off

Refinancing a Condominium?

Condo Assoc. Contact

Condo Contact Phone*

Monthly/Quarterly Association fee

Is water/sewer included in fee?

YesNo

Notes

Would you like to attach any documents?
(i.e., tax bill, insurance binder)

By submitting this form, I authorize Summit Title to receive any payoff information with regard to my/our loan.

For security purposes: Please add 1 and 3:

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