Refinance Questionnaire

Borrower
Property
Marital Status	Married Single
Male Spouse Name
Male SSN xxx-xx-xxxx
Female Spouse Name
Female SSN xxx-xx-xxxx
Email Address
Phone Number
Cell Number
Preferred Contact Time
Attending Closing	Yes No
If no, address to send final documents
Address 2
City
State
Zip
Phone
Fax
If you have cash out from your refinance, proceeds sent by:	FedEx Wire
Current Mortgage: Property Zip
First Mortgage Holder
Loan Number
Phone
First Mortgage Holder
Loan Number
Phone
Is there a Condo Association or Homeowner Association?	Yes No
Management Company
Phone
Contact
If this property is not a Condo a survey will be required.
Prior Survey	Yes No
Order Survey	Yes No
I hereby authorize Naples Title, Inc. to obtain payoff information on my behalf.

Please answer the simple math question below to submit the form.

2 + 2 =