Rollins, Rollins & Fox

Submit Your Buyer Information

BUYER INFORMATION

Personal Information (*required field)

Your New Lender:*

Your Name:*

Loan/Transaction Type:

Are you Purchasing a house?
Are you Refinancing your Existing Mortgage?
Are you taking out an Equity Mortgage?

Your Telephone:

Home:

Work:

Your Email Address:

Co-Borrower:

Co-Borrower Telephone:

Home:

Work:

Property Address:*

City*, State*, Zip:

Your Current Address:

City, State, Zip:

Purchase Information

Title Preference:

Joint Tenancy
Tenants in Common
Tenants by the Entirety
Individually (One Owner)

Your Attorney (If any or, If not our office):

Your Attorney Address:

City, State, Zip:

Phone:

Your Insurance Agency:

Phone:

Refinance Information

Current First Mortgage Lender:

Loan/Account Number:

Lender Telephone:

Current Equity / Second Mortgage Lender:

Loan/Account Number:

Lender Telephone:

Notes or Special Instructions
to us: