Full Name:  (Contact information:  email address, phone #’s)

Marital Status: Married      Not Married    Common Law (living together for more than 3 years)

Municipal Address of Property:

Legal Description if known:

Closing Date: (If closing date is tentative, kindly indicate Preferred Closing Date.)

Existing Mortgage/Line of Credit   Yes  No

Name of Banker & Contact Information  (email or phone #   Mortgage/Line of Credit Account #)