Buyer Information

Address of Purchased Property *

Will you be residing at the purchased property as your primary residence?*
YesNo

Closing date of this transaction *

1. Full Name(s) to appear on Title *

MaleFemale

Date of Birth *

2. Full Name(s) to appear on Title

MaleFemale

Date of Birth *

Marital Status *
MarriedSingleSeperatedDivorcedCommon Law

Number of years living together

Current Address *

Forwarding Address *

Telephone #’s

Cell *

Home *

Work

E-mail *

Title Information *
Solo OwnerJoint TenantsTenants in common

Are you a First Time Home Buyer *
YesNo

Mortgagee (Lender) Information

**Please ensure the mortgage lender is aware we are acting on your behalf and instructions are sent to our office at least 10 business days prior to closing**

Tel. Number *

Fax. Number

Tel. Number *

Fax. Number

Will there be Bridge Financing? *
YesNo

Home Owners Insurance Information:

**Please ensure your agent faxes a binder letter to our office prior to closing**

Tel. No *

Fax. No

Realtor Information

Tel. No *

Fax. No

CLIENT CONSENT

hereby confirm that

• a) Green Germann Sakran has been asked to act for both or all parties involved in our purchase/sale/mortgage transaction;

• b) No information received, in connection with the matter, from one, can be treated as confidential so far as any of the others are concerned; and

• c) That, if a conflict develops, which cannot be resolved, Green Germann Sakran cannot continue to act for both or all parties and may have to withdraw completely.

Date *

Client Name *

Client Signature *

Client Name *

Client Signature *

Enter the message as it's shown *

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