* REQUIRED FIELDS

Your Name: *

Phone Number you can be reached at: *

Your Email Address: *

PROPERTY TYPE*
Commercial / Industrial
New Construction
Residential / Single Family / Condo
Vacant / Bare land
Unknown
Other

TRANSACTION TYPE*
Cash
Construction Loan   12 Months 18 Months Over 18 Months
Contract
Conventional Insured
Conventional Uninsured
Foreclosure
Mortgage
Second Mortgage
Purchase
Refinance
Search
Unknown
Other

COUNTY*
Genessee
Macomb
Oakland
St. Clair
Wayne
Other

CURRENT OWNERS / SELLER INFO: *(For refinances or second mortgages, you are considered the seller)

IF SELLER IS A BUSINESS, FILL OUT THIS SECTION:

Business Name:

IF SELLER IS AN INDIVIDUAL, FILL OUT THIS SECTION:

Name:	Last	First	Middle	Marital Status	Husband and Wife
				A Single Man A Single Women A Married Man A Married Women
				A Single Man A Single Women A Married Man A Married Women	Yes No N/A
				A Single Man A Single Women A Married Man A Married Women
				A Single Man A Single Women A Married Man A Married Women	Yes No N/A

BORROWER / BUYER INFO: (For refinances or second mortgages, leave this section blank.)

IF BUYER IS A BUSINESS, FILL OUT THIS SECTION:

Business Name:

IF BUYER IS AN INDIVIDUAL, FILL OUT THIS SECTION:

Name:	Last	First	Middle	Marital Status	Husband and Wife
				A Single Man A Single Women A Married Man A Married Women
				A Single Man A Single Women A Married Man A Married Women	Yes No N/A
				A Single Man A Single Women A Married Man A Married Women
				A Single Man A Single Women A Married Man A Married Women	Yes No N/A

PROPERTY PROFILE: *

Address:

City, Village, Township:

State: MI Zip:

Legal Description: (if you are not sure leave blank)

Example: Lot 1 Stadler Estates Sub No.1 L. 55 P. 10

Owner's title work will be mailed to the above address unless otherwise specified here:

(Be sure to include phone number)

Name:

Address:

City:

State: Zip:

Phone: Ext:

Fax:

Contact:

Sale Price: $

Mortgage Amount: $

Date Needed: (mm/dd/yy)

Do you have an old abstract or policy for credit?
Yes
No
Don't know

LENDER INFO:

Lender Name:

Contact:

Address:

City:

State: Zip:

*Phone: Ext:

*Fax:

Attention:

Loan title work will be mailed to this address unless otherwise specified here:

Name:

Address:

City:

State: Zip:

Phone: Ext:

Fax:

Contact:

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