Property Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have a current mortgage on the property? *

Yes

No

How many loans do you have against the property *

One

Two

Three

None

1st Mortgage Phone

(###)

###

####

2nd Mortgage Phone

(###)

###

####

3rd Mortgage Phone

(###)

###

####

Is your home a part of a Condo / HOA management company? *

Yes

No

Condo / HOA Contact Name

First Name

Last Name

Condo / HOA Phone

(###)

###

####

Your Forwarding Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Sellers Signature *

By signing below, you authorize Minnesota River Valley Title & Abstracting the authority to request payoff information from your existing mortgage lender(s).

First Name

Last Name

Date *

MM

DD

YYYY

Best phone number to reach you *

(###)

###

####

By clicking YES below you acknowledge that you have read and understand all fields in this form. *

YES