Refinance Client Intake Sheet

REFINANCE RETAINER
By completing and returning this document, I/we acknowledge having retained the services of Hébert & Roy to complete our Refinance transaction and I/we give permission to the firm to commence work on my/our file.
- Yes
- No
Name
First Last
Date
Name
First Last
Date

I/we have dealt with your office in the past for (list type of service and date of service):
I/we was/were referred by:

1st Applicant
FULL LEGAL NAME
First Middle Last
Date of birth:
Marital status
*Common law spouses are defined as couples that have been living together in a conjugal relationship for three years or couples that are living together in a conjugal relationship and raising a child of whom both are natural or adoptive parents.
Name of spouse (if married):
If separated, indicate date of separation:
Gender
- Male
- Female
Canadian Citizen
- Yes
- No
Home:
Work:
Cell/pager:
Email address:
Enter Email Confirm Email
Occupation
PRESENT ADDRESS
Street Address Address Line 2 City Province Postal Code
2nd Applicant
FULL LEGAL NAME
First Middle Last
Date of birth:
Marital status
*Common law spouses are defined as couples that have been living together in a conjugal relationship for three years or couples that are living together in a conjugal relationship and raising a child of whom both are natural or adoptive parents.
Name of spouse (if married):
If separated, indicate date of separation:
Gender
- Male
- Female
Canadian Citizen
- Yes
- No
Home:
Work:
Cell/pager:
Email address:
Enter Email Confirm Email
Occupation
PRESENT ADDRESS
Street Address Address Line 2 City Province Postal Code

SUBJECT PROPERTY
Is property a Condominium:
- Yes
- No
Name and # of Condo Corp.
Total amount of property taxes for current year
(contact City or Municipality if unknown
Have property taxes been paid in full:
- Yes
- No
If property taxes have not been paid in full, indicate amount paid:
*please provide copy of most recent Tax Bill as soon as possible

EXISTING MORTGAGE / LINE OF CREDIT
Lender/bank name:
Branch location (if applicable):
Mortgage/Loan number (as indicated on statement) :
(Please complete if more than one outstanding mortgage):
Lender/bank name:
Branch location (if applicable):
Name of mortgage broker or contact person at bank:
Contact information for mortgage broker or contact person at bank:
FIRE INSURANCE
* you need to contact your insurance company and request that they send us an Insurance Binder
Insurance company/broker name:
Address
Street Address Address Line 2 City Province Postal Code
Contact person
First Last
Telephone number
Email address

DEBTS TO BE PAID
Please provide recent statements of any and all debts to be paid from proceeds of refinance and list the debts below:
File
Drop files here or

Accepted file types: jpg, gif, png, pdf, txt, doc, docx.

Please review your information and click the previous button to go back and make any necessary charges : {all_fields}
Phone
This field is for validation purposes and should be left unchanged.

REFINANCE RETAINER