Full Legal Name / Entity Name

First

Last

Entity Type (e.g., Individual, LLC, S-Corp, Partnership)

Tax ID / SSN

Advisor Printed Email/Phone

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Primary Contact Person

Phone Number

Email Address

Relinquished Property Address

Estimated Sale Price

Estimated Existing Mortgage Payoff

Expected Closing/Transfer Date

Closing Agent Name & Company

Closing Agent Email & Phone

Title Company File / Escrow Number

Replacement Property Address / Description (If unknown, write "TBD")

Estimated Purchase Price

Estimated New Mortgage Amount

Target Closing Date

Replacement Closing Agent Name & Company (if known)

Replacement Closing Agent Email & Phone

Tax Advisor / CPA Name

Tax Advisor / CPA Company

Tax Advisor / CPA Email/Phone

Real Estate Attorney / Broker Name

Real Estate Attorney / Broker Company

Real Estate Attorney / Broker Email/Phone

Printed Name & Title

Date