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Transaction Type:	Purchase Refinance Equity
Buyer/Borrower(s):		Example: John Q. Smith
		Example: Sally R. Smith
Seller(s):		Example: Christopher K. Public
		Example: Jennifer Public
Contract Sales Price:		Example: 195000.00
Earnest Money:		Example: 5000.00
Held/Received By:	Incoming Fund Seller Settlement Agent Listing Agent (701) Selling Agent (702)
Property Address:		Example: 1024 Elm Street
City:		Example: Raleigh
State:		Example: NC
Zip:		Example: 27606
County/Parish:		Example: Wake
Listing Agent Company Name:		Example: Remax
Phone:	(###)###-####	Example: (919)555-1234
Total Commission Rate %:		Example: 6
Selling Agent Company Name:		Example: United Realty
Phone:	(###)###-####	Example: (919)555-4321
Lender Name(s):		Example: Bank of USA
Street Address:		Example: 123 Main Street
City, State, Zip		Example: Raleigh, NC 27609
Settlement Date:	MM/DD/YYYY	Example: 10/03/2004
Time:	hh:mm	Example: 09:27
Settlement Status:	Firm Pending Tentative Completed Canceled Hold Set Closed Shipped Follow-Up
Status Comment:
Marketing Source:
Title Examiner:
Closer:
Escrower:
Bill to:	Lender Mortgage Broker Loan Servicer Buyer/Borrower Seller Settlement Agent
Order Notes:
Please include your email address below. You should receive a confirmation email shortly after you submit this form.
Your Email Address: