HARRIS & HILTON, P.A.

ATTORNEYS AT LAW

7320 Six Forks Road, Suite 100; Raleigh, North Carolina 27615

Telephone No.: (919) 848-6164 Facsimile No.: (919) 848-6918

Email:

LISTING AGENT: Phone No. Email:

Property Address: Buyer Name:

Closing Date:

1. Seller Full Name: Email:

2. Seller Marital Status: If Married, Spouse’s Full Name:

3. Seller New Address:

4. Seller Social Security Number: (him) (her)

5. Seller Contact Info:Phone: Email:

6. Is Seller a US Citizen: Yes No

7. Commission Total: Listing% Selling% Marketing Fee:

Commission Check: Will pick up: Mail to:

8. Existing Mortgage(s):

1st Mortgage2nd Mortgage

Lender: ** If the Seller has an outstanding equity line of credit

Loan/AcctNo:Seller must block/freeze the account prior to closing and send written evidence to our office.

Phone No:Lender:

Loan/AcctNo:

Phone No:

9. Homeowner Dues: Management Co: Phone No:

10. Does Seller want closing agent to prepare Deed, Lien Waiver, FIRPTAand 1099?

11. Please list any other charges or credits to be shown on HUD-1:

12. Sellercurrent Title Insurance Policy is with: (Look on HUD from purchase/refi for company name)

13. Will the Seller attend the closing?

14. Name of Lien Agent per N.C.G.S. 44A, Article 2?

(Does not apply if property being sold is owner’s existing single family residence)

15. Seller Proceeds: Wire ($35 fee): Mail to New Address: Will Pick Up:

(Include Wiring Instructions)

Please return Seller’s loan/payoff information as soon as possiblealong with the signed authorization on the following page as it could take up to 10 days to receive payoff statements.

AUTHORIZATION

I/We authorize the closing attorney, Harris & Hilton, P.A., to receive any and all information and documentation requested in order to assist them in obtaining loan and payoff information for loans owed to said lender(s) and/or HOA. I understand the lender may charge a fee to my account for a faxed written payoff statement. Lender is asked to forward any requested information in a prompt manner. A copy of this authorization may be accepted as an original.

If the loan is an Equity Line or similar revolving line of credit, I/We hereby request that the account be blocked from further advances, suspend further credit, and terminate the accountpursuant to N.C.G.S. 45-82.2.. The information Harris & Hilton, P.A. obtains is only to be used in the processing of my mortgage loan closing. This Request for Payoff Statement and Credit Suspension Directive (this “Request and Directive”) is a combined request for a payoff statement given pursuant to § 45-36.7 of the North Carolina General Statutes and a credit suspension directive given to you pursuant to § 45-36.7A of the North Carolina General Statutes.

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Name/Signature: Date

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Name/Signature Date

WIRE TRANSFER AUTHORIZATION FORM

I/We, the undersigned, do hereby request and authorize Harris & Hilton P.A. to wire my/our proceeds from the sale of property located at ______to the following bank account. Furthermore, I/we acknowledge that any changes to these wiring instructions will only be accepted via a revised signed authorization form presented at closing. Revised authorization forms transmitted via electronic mail will not be honored.

Bank: ______

Address: ______

Routing Number: ______

Account Number: ______

Name as it Appears on Account: ______

IN WITNESS THEREOF, this ______day of ______, 2015.

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Printed Name:

______

Printed Name:

ATTACHED VOIDED CHECK OR DEPOSIT SLIP FOR ACCOUNT