Home l Main Page l Staff Contacts Type of transaction: Purchase Refinance Second Mortgage/HELOC Property Address: County: Property Use: Principal Residence Investment Property (includes 2nd homes) Buyer's Information: Name: Phone (Work): Phone (Home): Email: Other Info: Social Security Numbers: Seller’s Information: Name: Phone (Work): Phone (Home): Email: Other Info: Social Security Numbers: Buyer’s Agent Information: Name: Company Name: Office Address: Phone (Office): Phone (Cell): Email: Seller’s Agent Information: Name: Company Name: Office Address: Phone (Office): Phone (Cell): Email: Settlement Information: Estimated Date of Closing: Purchase Price: Approximate Amount of New Loan: Name of Lender: Contact Number: Loan Officer: Will buyers/sellers be able to attend closing? Yes No Are all the purchasers first-time homebuyers in the state of Maryland? Yes No Any other information?

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Peninsula Settlements, LLC - 444 North Frederick Avenue, Suite 316 - Gaithersburg, Maryland 20877 Telephone: (240) 631-6690 Facsimile: (240) 631-6556 www.peninsulasettlements.com