WELCOMEThank you for the opportunity to assist you with the refinance of your property. In order for us to close your transaction quickly and efficiently, please complete all applicable blanks and checkboxes in the form below. Per Florida state law, all of the information provided will be kept strictly confidential. Should you have any questions or need assistance completing this form, please contact the processor on your file.Property Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwePlease provide copies of your selling entity’s formation documents.Borrower NamePlease provide exact name as listed in the public record.Tax Identification NumberState of FormationAuthrorized SignorPlease also send a clear copy of your drivers licence or passport along with your completed form.PhoneCell PhoneEmail AddressPost Closing Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweWill Borrower #1 be present to sign your closing documents at our office at the time of closing?YesNoIf Borrower #1 will NOT be present, where will Borrower #1 be for closing?The majority interest is owned by a:U.S. CitizenPermanent ResidentOtherHas the Borrower recently filed for bankruptcy?YesNoAre you aware of any leins or judgments against the Borrower?YesNoIf yes, please list them:Do you have a title insurance policy?YesNoPlease fax or email a copy of the policy IMMEDIATELY. If your contract is a NABOR contract, you have 10 days to provide this policy.Do you have a survey for the property?YesNoHave you made improements of any kind to the EXTERIOR of your property?YesNoIs the property leased?YesNoIf yes, please forward a copy of the lease agreement as soon as possible.To whom do you make your water/sewer bill payment?Are there mortgages on the property?YesNoFirst Mortgage Holder Bank NameLoan NumberCustomer Service Phone NumberSecond Mortgage Holder Bank NameLoan NumberCustomer Service Phone NumberDo you pay dues to a HOA/Condo Association?YesNoMaster/Condo Association NamePhoneFaxNeighborhood Association NamePhoneFaxDISCLOSURESAT CLOSING, YOU WILL DESIGNATE WHETHER YOU WANT A CHECK OR A WIRE FOR YOUR PROCEEDS. PLEASE BE PREPARED WITH YOUR BANK WIRE ROUTING INFORMATION IF WANT YOUR PROCEEDS WIRED. THIS REQUIRES YOU TO CALL YOUR BANK AND CONFIRM THE WIRE ROUTING NUMBER AS IT WILL LIKELY BE DIFFERENT THAN THE INFORMATION ON YOUR CHECKS. I /we, the undersigned, hereby certify that all of the information provided on this Buyer Information Form is true, correct and accurate to the best of our knowledge. I/we also acknowledge that providing false information in an attempt to commit fraud could subject us to state and federal criminal and civil penalties. Pursuant to Florida law, I/we agree to pay Paradise Coast Title’s standard fees and reimburse Paradise Coast Title & Escrow for any monetary advances made on my/our behalf for items, including but not limited to, estoppels, lien searches, application fees, etc. PLEASE BE ADVISED: Paradise Coast Title & Escrow, LLC does not provide legal advice. Unless otherwise expressly stated in writing, Sam J. Saad III does not represent the buyer or seller in your transaction. As settlement agent, our duties are to: (i) prepare the necessary legal documents that will consummate the transaction contemplated by the Purchase Agreement (the “Contract”); (ii) ensure that applicable settlement documents are properly executed; (iii) ensure that costs and expenses are allocated between the parties pursuant to the terms of the Contract; (iv) arrange for the payment and disbursement of closing proceeds and costs; (v) arrange for the recording of appropriate documents in the public records; and (vi) arrange for the issuance of the title insurance commitment and policy(ies). Please date and sign or type* your name below:Borrower Authorized PersonDate*By typing your name above you agree to the following: By typing in your legal name, you are signing this form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this form. By typing in your legal name you consent to be legally bound by this form's terms and conditions. Send Message