Refinance Borrower Information Sheet - Cobalt Settlements

Step 1 of 7

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Borrower 1
Full Legal Name*
Prefix First Middle Last Suffix
Social Security Number
Email*
Preferred Phone Number*
Borrower 1 Signature*
Your signature above will direct Cobalt Settlements, LLC to commence title services and request a payoff statement from applicable lenders.
Please use the track pad or mouse on a computer or stylus/finger if using a mobile device.

Borrower 2
Full Name
Prefix First Middle Last Suffix
Social Security Number
Email
Preferred Phone Number
Second Borrower Signature
Your signature above will direct Cobalt Settlements, LLC to commence title services and request a payoff statement from applicable lenders.
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

New Loan Officer/Lender Information (Please include Home Equity or 2nd Trust Lender information)
First Loan Officer/Lender Information Name
First Loan Officer/Lender Information Phone Number
Second Loan Officer/Lender Information Name
Second Loan Officer/Lender Information Phone Number

Current Lender Information (Please include Home Equity or 2nd Trust Lender information)
Lender Name
Lender Phone Number
Loan Number
Second Lender Name
Second Lender Phone Number
Second Loan Number
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 Seller giving Power
The Seller is giving Power to

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
Untitled
- First Choice
- Second Choice
- Third Choice
Phone
This field is for validation purposes and should be left unchanged.

Arlington Office

4600 N Fairfax Drive
Suite 104
Arlington, VA 22203

Alexandria Office

211 North Union Street
Suite 100
Alexandria, VA 22314