Seller Form | Cobalt Settlements, LLC

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Seller 1
Full Legal Name*
Prefix First Middle Last Suffix
Social Security Number
Email*
I would like my settlement documents delivered:
- Electronically to the email address above
- Hard Copy
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
For IRS purposes, please check one*
- U.S. Citizen
- Resident Alien
- Non Resident Alien (please contact Cobalt Settlements)
Forwarding Address*
Street Address Address Line 2 City State ZIP Code
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 seller without express, written authorization of the seller. By signature below, the seller 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.
Seller 1 Signature*
Your signature above will direct Cobalt Settlements, LLC to commence title services and request a payoff statement from applicable lenders and authorizes the sharing of 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.

Seller 2
Full Name
Prefix First Middle Last Suffix
Social Security Number
Email
I would like my settlement documents delivered:
- Electronically to the email address above
- Hard Copy
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
For IRS purposes, please check one
- U.S. Citizen
- Resident Alien
- Non Resident Alien (please contact Cobalt Settlements)
Forwarding Address
Street Address Address Line 2 City State ZIP Code
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 seller without express, written authorization of the seller. By signature below, the seller 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.
Second Seller Signature
Your signature above will direct Cobalt Settlements, LLC to commence title services and request a payoff statement from applicable lenders and authorizes the sharing of 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
HOA Name
HOA Fee
Fee Frequency
HOA Contact Information

Lender Information (Please include Home Equity or 2nd Trust Lender information)
Lender Name
Lender Phone Number
Loan Number
2nd Lender Name
2nd Lender Phone Number
2nd 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
Phone
This field is for validation purposes and should be left unchanged.

Arlington Office

4600 N Fairfax Drive
Suite 104
Arlington, VA 22203

Connect With Us

Name*
First Last
Email*
Message*
Name
This field is for validation purposes and should be left unchanged.

Alexandria Office

211 North Union Street
Suite 100
Alexandria, VA 22314

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