Buyer 1

Legal Name*

Prefix First Middle Last Suffix

Social Security Number

Email*

Preferred phone number*

(this phone number will be used should Cobalt Settlements need to verify any information related to settlement funds)

Marital Status*

Married
Single

Is the property you are purchasing going to be your principal residence?*

Yes
No

Due to recent regulatory changes, Cobalt Settlements, LLC is prohibited from sharing certain settlement related information with the realtors representing the parties to the transaction and other representatives of the purchaser without express, written authorization of the purchaser. By signature below, the purchaser authorizes Cobalt Settlements, LLC as follows:*

Please provide my realtor with a copy of my Closing Disclosure or settlement statement.
Please DO NOT provide my realtor with a copy of my Closing Disclosure or settlement statement.
Not applicable as I do not have realtor representation in the transaction.

Buyer 1 Signature*

Your signature above will direct Cobalt Settlements, LLC to request a title search and survey (if requested), acknowledges your agreement to pay for these services should settlement not occur, and authorizes the sharing of the information in accordance with the direction above.
Please use the track pad or mouse on a computer or stylus/finger if using a mobile device

Buyer 2

Legal Name

Prefix First Middle Last Suffix

Social Security Number

Email

Preferred phone number

(this phone number will be used should Cobalt Settlements need to verify any information related to settlement funds)

Marital Status

Married
Single

Is the property you are purchasing going to be your principal residence?

Yes
No

Due to recent regulatory changes, Cobalt Settlements, LLC is prohibited from sharing certain settlement related information with the realtors representing the parties to the transaction and other representatives of the purchaser without express, written authorization of the purchaser. By signature below, the purchaser authorizes Cobalt Settlements, LLC as follows:

Please provide my realtor with a copy of my Closing Disclosure or settlement statement.
Please DO NOT provide my realtor with a copy of my Closing Disclosure or settlement statement.
Not applicable as I do not have realtor representation in the transaction.

Buyer 2 Signature

Your signature above will direct Cobalt Settlements, LLC to request a title search and survey (if requested), acknowledges your agreement to pay for these services should settlement not occur, and authorizes the sharing of the information in accordance with the direction above.
Please use the track pad or mouse on a computer or stylus/finger if using a mobile device

Property Information

Full Property Address*

Street Address Address Line 2 City State ZIP Code

Loan Officer/Lender Information (Please include Home Equity or 2nd Trust Lender information)

Loan Officer/Lender Information 1 Name

Loan Officer/Lender Information 1 Phone Number

Loan Officer/Lender Information 2 Name

Loan Officer/Lender Information 2 Phone Number

Survey

A survey will provide you with the extent and layout of the property you are purchasing and is highly recommended. Cobalt WILL ONLY order a survey if you specifically request us to do so.

Would you like a survey?*

Yes, I would like a survey: House Location (approx.. $350)
Yes, I would like a survey: Staked Survey (iron stakes at all corners, approx.. $450-$500)
No, I would not like a survey
No, property is a condominium

Power of Attorney

Will you be using a Power of Attorney?*

Yes
No

Cobalt Settlements can coordinate the preparation of the power of attorney. ($125 Fee)*

Yes, I would like Cobalt Settlements, LLC to coordinate the preparation of POA.
No, thank you.

Name of individual giving Power*

First Last

The individual is giving Power to*

First Last

Please note that all POA’s must be approved by Cobalt Settlements in advance of closing.

Would you like to schedule a conference call with one of Cobalt's settlement attorneys to discuss your transaction? If so, an attorney will contact you at the email address above to schedule a call.*

Yes
No

Special Instructions

Name

This field is for validation purposes and should be left unchanged.

Buyer / Borrower Information Sheet