Note: This form is intended for the purpose of requesting a HUD 1 only and is not applicable to CFPB/TRID transactions.

Please Fill Out Form Completely and then Submit at Bottom of Page.

*Required Fields

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*Choose Escrow Officer:  
*Choose Sales Representative:  
*Full Name:  
*Phone:  - xxx xxx-xxxx
Fax:  - xxx xxx-xxxx
*Company Name:  
*Subject Property Address:  
*Subject Property City:  
*Is this for a Short Sale?:  Yes No
*Sales Price:  
*Commission Amount:  
*Termite:  Yes No
If Yes Cost:
*Septic:  Yes No
If Yes Cost:
*Home Warranty: Yes No
If Yes Cost:
*National Hazard Disclosure (NHD):  Yes No
*Is Seller Paying any Buyers Closing Fees?:  Yes No
If Yes Amount:
*Is it a Normal Split on the Title and Escrow fees?:  Yes No
If No Please Explain:
*1st Loan Payoff:   Yes No Yes, Amount Not Available
If Yes 1st Loan Payoff Amount: Estimated?
*2nd Loan Payoff:  Yes No Yes, Amount Not Available
2nd Loan Payoff Amount: Estimated?
*Is there a HOA?:  Yes No
If Yes is the Seller Current: Yes No
If No what is the Outstanding HOA Balance:
Monthly Dues:
What is the Estimated Transfer Fee and Doc Fees from the HOA?:
*Any Additional Repairs to to Add to Estimate?:  Yes No
If Yes Amount:
*Any Additional Liens to be Paid?:  Yes No
If Yes Please Explain and Provide Amounts:
Any Additional Comments:


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