Step 1 of 8 12% Submitter InformationSubmitter's Name* First Last Submitter's Phone*Submitter's FaxSubmitter's Email* Submitter's Company* General InformationEstimated Settlement Date* MM slash DD slash YYYY Property Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Loan Purpose*Please SelectRefinancePurchaseOtherLoan Type*Please SelectFHAVAThird ChoiceCONVCDOtherSurvey*Please SelectYesNoOwner Occupied*Please SelectYesNo Buyer / Borrower InformationBuyer's (1) Name* First Last Buyer's (1) Home Phone*Buyer's (1) Work Phone*Buyer's (1) Social Security #* Buyer's (2) Name First Last Buyer's (2) Home PhoneBuyer's (2) Work PhoneBuyer's (2) Social Security # 1st Time Homebuyer*Please SelectYesNoBuyer's Real Estate Agent* Buyer's Real Estate Agent Phone*Buyer's Real Estate Agent Fax Seller InformationSeller's (1) Name* First Last Seller's (1) Home Phone*Seller's (1) Work Phone*Seller's (1) Social Security #* Seller's (2) Name First Last Seller's (2) Home PhoneSeller's (2) Work PhoneSeller's (2) Social Security # Seller's Real Estate Agent* Seller's Real Estate Agent Phone*Seller's Real Estate Agent Fax Lender's InformationLender's Name* First Last Lender's Phone*Lender's Fax*Purchase Price*Loan Amount*Loan Number*Mortgage Clause Broker InformationLoan Officer* First Last Broker's Phone*Broker's Fax*Processor* First Last Processor's Phone*Processor's Phone* Payoff InformationExisting Mortgage* Existing Mortgage Phone*Existing Mortgage Account #* Second Mortgage* Second Mortgage PhoneSecond Mortgage Account # Any Comments or Notes
