Law office of Philip C. Nessralla, Jr.

Real Estate
Personal Injury
Litigation
Family Law
Contract Law
Municipal Law
Zoning
Immigration

Borrower Information

Personal Information

Your New Lender:*

Your Name:*

Loan/Transaction Type:

Are you Purchasing a house?
Are you Refinancing your Existing Mortgage?
Are you taking out an Equity Mortgage?

Your Telephone:

Home:

Work:

Your Email Address:

Co-Borrower:

Co-Borrower Telephone:

Home:

Work:

Property Address:*

City*, State*, Zip:

Your Current Address:

City, State, Zip:

Purchase Information

Title Preference:

Joint Tenancy
Tenants in Common
Tenants by the Entirety
Individually (One Owner)
Joint Tenancy
Tenants in Common
Tenants by the Entirety
Individually (One Owner)

Your Attorney (If any or, If not our office):

Your Attorney Address:

City, State, Zip:

Phone:

Your Insurance Agency:

Phone:

Refinance Information

Current First Mortgage Lender:

Loan/Account Number:

Lender Telephone:

Current Equity / Second Mortgage Lender:

Loan/Account Number:

Lender Telephone:

Notes or Special Instructions to us:

1063 North Main Street, Brockton, MA 02301 | 508-583-1030 | 508-584-0543 FAX | pcn@nessrallalaw.com

Authorized agent of First American Title Insurance

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