Sale Client Intake Sheet Step 1 of 5 20% SALE RETAINERBy completing and returning this document, I/we acknowledge having retained the services of Hébert & Roy to complete our Sale transaction and I/we give permission to the firm to commence work on my/our file.YesNoName First Last Date Name First Last Date Are you also purchasing a property?YesNoIf yes, when is the closing date? Are we acting for you on the purchase of your new home?YesNoIf your purchase is closing before your sale, are you obtaining a bridge loan?YesNoIf we are not acting on your purchase, please provide your forwarding address: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:Name of real estate agent, if applicable:Name of mortgage brokers, if applicable: 1st ApplicantFULL LEGAL NAME First Middle Last Date of birth:Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Marital statusSingleMarried*Common LawSeparatedDivorcedWidowed*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.If separated, do you have a Separation Agreement:YesNoFileName of spouse (if married):GenderMaleFemaleCanadian CitizenYesNoSpecial instructions/comments:Home:Work:Cell/pager:Email address: Enter Email Confirm Email Employer/ address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Occupation2nd ApplicantFULL LEGAL NAME First Middle Last Date of birth:Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Marital statusSingleMarried*Common LawSeparatedDivorcedWidowed*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:Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920GenderMaleFemaleFirst time home buyer ?YesNoCanadian CitizenYesNoSpecial instructions/comments:Home:Work:Cell/pager:Email address: Enter Email Confirm Email Employer/ address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code OccupationSUBJECT PROPERTYAre you residing on the subject property:YesNoType of heatGasElectricOilIs hot water tank rental:YesNoTotal amount of property taxes for current year (contact City or Municipality if unknown):Have property taxes been paid in full:YesNoIf 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 / BRIDGE LOANType of loan: Mortgage Line of Credit Bridge Loan (please select all applicable)Lender/bank name:Branch location (if applicable):Mortgage/Loan numberContact information for mortgage broker or contact person at bank:(Please complete if more than one outstanding mortgage):Type of loan: Mortgage Line of Credit Bridge Loan (please select all applicable)Lender/bank name:Branch location (if applicable):Branch location (if applicable):Contact information for mortgage broker or contact person at bank: Please review your information and click the previous button to go back and make any necessary charges : {all_fields}Required Information: We are required to obtain certain information from you as a condition of providing you with our services. The list of required information is as follows: Identification (two of the following) : Driver’s Licence, Passport, credit card, SIN card, Government issued employment card with photo. This must be provided AT THE TIME OF YOUR APPOINTMENT ONLY; Most recent Tax Bill, if tax information is not provided 10 days before closing; we must order a Tax Certificate at a cost of $95.00 that will be charged to your account. CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.
