Pinnacle Title & Escrow, Inc. - Buyer's Information

Property Address

If property will not be the buyer's principal residence, please provide current address

Buyer's Primary Phone
- Area Code Phone Number
Buyer's Secondary Phone
- Area Code Phone Number
Buyer's Email Address
Buyer's SS Number
Marital Status
Co-Buyer (if applicable)
Co-Buyer's Name
First Name Middle Name Last Name Suffix
Co-Buyer's Primary Phone
- Area Code Phone Number
Co-Buyer's Email Address
Co-Buyer's SS Number
Lender Information
Lender/Bank's Name
Loan Officer's Name
First Name Last Name
Loan Officer's Phone
- Area Code Phone Number
Loan Officer's Email
Termite & Hazard Information
Will a termite inspection be done on this property?
If yes, please fax the report when completed to fax (301) 424-6896
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Please fax paid receipt or invoice for homeowner's insurance to fax (301) 424-6896
Selling Agent Information
Selling Agent
First Name Last Name
Company
Email
Phone
- Area Code Phone Number
Fax
- Area Code Phone Number
Administrative Fee
Commission Percentage
Home Warranty Information
Is the buyer obtaining a home warranty policy?
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Please fax home warranty application as soon as possible to fax (301) 424-6896
Warranty Company:
Amount of Premium:
Survey Information
Will Pinnacle Title be ordering a survey on this property?
If yes, we will need you to complete and submit an order form. Please provide the email address or fax number you would like it sent to:
Should be Empty:

Pinnacle Title & Escrow, Inc. 51 Monroe Street, Suite 1505
Rockville, MD 20850 301-424-5400 Fax: 301-424-6896

Buyer's Information