Refinance Information Sheet

Please complete this questionnaire as completely and accurately as you can.

All information that you provide will be held in strict confidence.

Legal First Name

Legal Middle Name

Legal Last Name

Other names used in the past

Current Address

Mailing Address if Different Than Above

Home Phone

Cell Phone

Work Phone

Email

By providing me email address I authorize McDuffy Law Firm, PLLC may send me emails concerning my case.

Last 4 of Social Security Number

Spouse Full Legal Name

Last 4 of Social Security Number (Spouse)

Home Phone (Spouse)

Cell Phone (Spouse)

Work Phone (Spouse)

Email (Spouse)

Street Address of Property Being Refinanced

Is the property being refinanced your primary residence?

Yes

No

Does the property have a mortgage or deed of trust? *

Yes (if yes complete loan information below).

No

Mortgage/bank contact information

Loan Number(s)

Do you authorize our office to obtain loan information from your lender including but not limited to a payoff statement?

Yes

No

Will the seller be at closing?

Yes

No

If no, where will your documents be sent? (UPS mailing fee will be collected at closing)

Is the property governed by a Home Owners Association?

Yes

No

Home Owners Association company name

Home Owners Association phone number

Home Owners Association email address

Home Owners Association fees

Do you authorize our office to obtain HOA information from a third-party company if applicable? Additional fees may be associated with this.

Yes

No

PLEASE ACKNOWLEDGE THE FOLLOWING IMPORTANT STATEMENTS & SIGN BELOW:

I have completed this form as fully and accurately as possible and have not knowingly provided any false statements.

Signature

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Signature

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Today's Date

The undersigned has engaged CERTIFID, INC. to provide payoff quote services in connection with the above-referenced property and any loan(s) secured by it (the "Loan") and hereby authorizes and approves the release of any and all information and the performance of any and all actions requested by CERTIFID, INC. relating to the Loan, including by not limited to providing any outstanding balance, payoff statement, and/or satisfaction/release status.

I/We hereby accept, acknowledge, and authorize the collection of any fees and/or charges necessary to generate, deliver, and expedite the payoff request.

Signature

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Today's Date