Refinance / Second Mortgage

Type of Transaction

TRID Compliant Loan

*Select Yes or No:

Property Information

*Property Address

*City

*State

*Zip

*County

Legal Description

Property Type

Buyer/Borrower(s):

*Complete Name(s)

Marital Status:  married single

Current Address (City, State & Zip)

Phone No - Please use this format: (###) ###-####

Cell Phone No - Please use this format: (###) ###-####

Email

Loan Amount

Please use this format: $1,234.10

Lender Information

*Company Name

NMLS #

State License ID State

Complete Address (City, State & Zip)

Loan No.

Loan Officer

Name

NMLS #

State License ID State

Phone No - Please use this format: (###) ###-####

Cell Phone No - Please use this format: (###) ###-####

Email

Loan Processor

Name

Phone No - Please use this format: (###) ###-####

Cell Phone No - Please use this format: (###) ###-####

Email

Closing Protection Letter (CPL)

CPL Required?  yes no

Complete Address for CPL (City, State & Zip)

Closing

Is Thomson-Affinity Title Closing?  yes no

Closing Office/Closer

Liberty:

Overland Park:

Closing Date

Ordered By

Your Name

Company

Address (City, State & Zip)

Phone No - Please use this format: (###) ###-####

Cell Phone No - Please use this format: (###) ###-####

*Email

Additional Copies To (Realtors, Attorneys, Surveyors, Additional parties, etc.):

Contact Name Company Name Phone No Email

Special Instructions

Please enter this text in the field below:
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