Refinance Authorization

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"*" indicates required fields

Settlement cannot be scheduled until this information is received in our office.
Refinance Authorization to Release Information

I/We hereby authorize Melissa A. Harrison, Attorney at Law, or her representatives, to obtain any payoff balance information regarding any Mortgages or Judgments that may be filed regarding my upcoming closing.

First Party

Signature*

Date*

Social Security #*

Daytime Phone #*

Email*

Legal Name as appears on Drivers License:*

Address Verification*

Street Address City State / Province / Region ZIP / Postal Code

Second Party

Signature*

Date*

Social Security #*

Daytime Phone #*

Email*

Legal Name as appears on Drivers License:*

Address Verification*

Street Address City State / Province / Region ZIP / Postal Code

Marital Status*

Legally Married

Legally Single

If you currently make payments on your home to a bank and/or any other creditor/lender or have a Home Equity Loan, please provide: name of your bank, account number, and the bank's or lender's phone number and/or phone number or loan officer.

Lender Name*

Customer Service Phone Number*

Account#*

Lender Name*

Customer Service Phone Number*

Account#*

Is there currently a mobile home on the property?*

Yes

If yes, please return a copy of the title to the mobile home.

Has a survey been done on the property?*

Yes

If yes, please return surveyed legal description.

Condominium or Homeowners Association Name:*

Monthly Amt. $*

Contact Person*

Phone #*

File

Max. file size: 32 MB.

This field is for validation purposes and should be left unchanged.

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