WHEN READY TO BEGIN YOUR EXCHANGE

Two weeks prior to your closing complete this form and fax along with the contract (Purchase and Sales Agreement) to: Base Company 678-298-1616.

Your Name: ___________________________________________________________   

1) Name that appears on title:  _____________________________________________

      ____________________________________________________________________                                                                 

2) Your Address: ________________________________________________________

                              ________________________________________________________

3) SS# or Tax ID: ________________________________________________________

Home Phone: __________________________ Office: ___________________________

 Cell Phone: _____________________________ Fax: ___________________________

 E-Mail Address: ___________________________________________________                       

5) Property Address Selling: _______________________________________________

                                                _______________________________________________

Buyer’s Name: __________________________________________________________

Date Contract Signed & Sales Price: __________________ $____________________

Closing Attorney:      _____________________________________________________

Contact Person: _______________________________ Date of closing: ____________

Attorney phone: __________________________ Fax: __________________________

E-Mail (if available) ________________________________________