Buyer Information Form If you are a human and are seeing this field, please leave it blank. * Required Field State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Broker's Commissions: Buyer #1: Marital Status * SingleMarriedSeparatedWidowed Buyer #2: Marital Status SingleMarriedSeparatedWidowed Closing Details: Is This Purchase as Second Home? * YesNo To be Primary Residence? * YesNo Mail Away Closing? * YesNo Power of Attorney Closing? * YesNo Lender Information: Third Party Services / Service Providers: HOI/Flood Insurance * YesNo HOA Company * YesNo Home Inspection * YesNo Home Warranty * YesNo Survey * YesNo Pest Inspection * YesNo Termite Bond * YesNo Other * YesNo PLEASE NOTE: ALL funds needed to close MUST be delivered via wire at time of closing. Email/fax closing information to: contact@humphriesfirm.law OR 888-290-7817