Mattingly Ford Title Insurance LLC Main Office
1650 UPS Dr. Ste 101
Louisville, KY 40223
502.212.7000
1.866.561.8747

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Real Estate Professional Questionaire Form

Agent Information
Name:
Company:
Office Phone Number:
Mobile Phone Number:
Fax Number:
E-Mail Address:
Property Information
Street Address:
City:
State:
Zip:
Transaction Information
Sale Price:
Commission:
%
Buyer's Agent: %
Seller's Agent: %
Based On:
Earnest Deposit:
Held By:
Bring to Closing:
Yes   No
Termite Report: (1) $ or N/A
(2) Payable To
(3) Expense Of
    Seller   Buyer   Other  
(4) POC   Collect at Closing
Home Warranty: (1) $ or N/A
(2) Payable To
(3) Expense Of
    Seller   Buyer   Other  
Home Owner Association:
Contact:
Phone Number:
Payment:
Paid current by seller?:
or N/A
$ per year month
yes no
Seller Information
Name of Seller One:
SSN of  Seller One:
Seller One - Marital Status:
Seller One - Spouse:
Name of Seller Two:
SSN of  Seller Two:
Seller Two - Marital Status:
Seller Two - Spouse:
Home Phone:
Work Phone:
Fax:
Email:
Forwarding Address:
Payoff #1: N/A
Lender Name:
Phone Number:
Account Number:
Payoff #2: N/A
Lender Name:
Phone Number:
Account Number:
Seller Paid Closing Cost(s):
Additional Misc. Fees:
Will Seller be using POA at Closing?
If Yes, Will MFTS Prepare? 		Yes   No  
Yes   No  
Note: If MFTS is not preparing, we will need to review the POA as soon as possible. Please forward to your setup paralegal.
* We will order payoff(s), but will need the Seller(s) signature(s) on the Information Disclosure Authorization form (see forms page of this website)
Is Seller a Corporation or LLC?
If Yes: 		Yes   No
Who will sign?
Title of Signator
If Seller is a Corporation or LLC, please forward corp./company resolution or operating agreement to MFTS
Is Seller a Trust?
If Yes: 		Yes   No
Name of Trustee
If Seller is a Trust, please forward trust agreement to MFTS
Buyer Information
Name of Buyer One:
SSN of  Buyer One:
Buyer One - Marital Status:
Buyer One - Spouse:
Name of Buyer Two:
SSN of  Buyer Two:
Buyer Two - Marital Status:
Buyer Two - Spouse:
Home Phone:
Work Phone:
Fax:
Email:
Additional Misc. Fees:
Does Buyer want Owners Title Insurance? Yes   No  
Will Buyer be using POA at Closing?
If Yes, Will MFTS Prepare? 		Yes   No  
Yes   No  
Note: If MFTS is not preparing, we will need to review the POA as soon as possible. Please forward to your setup paralegal.
Additional Information

SERVICES
Residential & Commercial Transactions
Escrow Closing Services
Title Searches & Reports
Title Insurance
Witness Closings
Government Loans
UCC Searches & Reports
Investment Property
General Expertise in Real Estate Transactions
Full Utilization of Technology
E-Sign Certified
OUR LOCATIONS
Louisville, KY
New Albany, IN
Lexington, KY
Elizabethtown, KY
Indianapolis, IN

~ More Info ~
Meet the Staff!
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