Locations:
4550 West 109 Street, Suite 150
Overland Park, KS 66211
T: 913-948-7780 | F: 913-948-7785

3520 West 75th Street, Suite 201
Prairie Village, KS 66208
T: 913-742-7780 | F: 913-742-7785

Licensed in the states of
Missouri & Kansas

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Transaction Type:
Purchase Refinance
Property Information:
Property Address:
City:
State:
Zip:
County:
Subdivision:
Lot/Block:
Purchaser/Borrower Information:
Purchaser/Borrower 1 (P1):
Purchaser/Borrower 2 (P2):
Office Phone (P1):
Office Phone (P2):
Home Phone:
Fax:
Present Address
City, State, Zip:
Married:
Seller Information (Purchase Transactions Only):
Seller 1 (S1):
Seller 2 (S2):
Office Phone (S1):
Office Phone (S2):
Home Phone:
Fax:
Present Address:
City, State, Zip:
Married:
Loan Information:
New Loan Information:
Lender:
Loan Officer:
Phone No.:
Sales Price:
Loan Amount:
Loan Type:
Existing Loan Information:
Lender (1st):
Acct Number:
Phone No.:
Lender (2nd):
Acct Number:
Phone No:
REALTOR Information (Purchase Transactions Only):
Selling Agent:
Name:
Office:
Office Phone:
Alt. Phone:
Fax:
Listing Agent:
Name:
Office:
Office Phone:
Alt. Phone:
Fax:
Special Instructions:

   

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