Tell us about yourself and your property…

Last Name First Name
Address
City State Zip Code
Daytime Phone Number Fax Number
Email Address

Address of Sale Property (if different than above):
Street
City State Zip Code

Estimated Sales Price

Have you purchased or refinanced this property in the last 5 years? YES NO

Is there a loan on the property? YES NO

If yes…

Approximate Balance
Approximate Interest Rate

Are there additional loans on the property? YES NO

If yes…

Approximate Balance
Approximate Interest Rate

Approximate amount of tax bill:

Commission to Real Estate Brokers (Standard 3% to listing agent and 3% to selling agent)?
YES NO

Has a termite inspection report been done on property within the last two years?
YES NO

Is the property part of a Homeowners Association or Planned Unit Development
YES NO

If yes…
Monthly Dues
Any Special Assessments? YES NO

If yes…
Amount of Special Assessments

Approximate planned close of escrow date:

Click here to submit and we will send you a preliminary estimate of closing costs:

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NETTIE BECKER ESCROW, INC. OFFICES (Beverly Hills and Encino)

301 North Canon Drive • Beverly Hills, CA 90210 • PH: 310-275-4042 • Fax: (310) 275-1219

17337 Ventura Blvd. Suite 105 • Encino, CA 91316 • PH: 818-783-7443 • Fax: (818) 783-2614