BORROWER INFORMATION SHEET

Please return this form by mail to Brian McCaffrey, Attorney at Law, 8818 Sutphin Blvd., 1st Fl., Jamaica, NY 11435
Please print clearly, this information is used to prepare documents.
Borrower One:

Borrower Two:

____________________________

__________________________

Social Security Number:

Social Security Number:

_____________________________

__________________________

DOB: ____________

DOB: ___________

Daytime phone number:

Daytime phone number:

__________________________

__________________________

Evening phone number:

Evening phone number:

___________________________

___________________________

Cell number:

Cell phone number:

__________________________

___________________________

Property liens:
First mortgage holder:

Second mortgage holder:

Name ________________________

Name _________________________

Address _______________________

Address _______________________

_______________________
Phone #

_______________________

______________________

Phone #

Loan # ______________________

______________________

Loan # ______________________

We authorize Brian McCaffrey, Attorney at Law to communicate with the above referenced lenders on our
behalf in regards to the mortgages held by them:
___________________________
Signature

____________________________
Signature

Home Owners Insurance Agent______________________ Phone _______________

Company_________________ Premium:___________Paid Through______________
If this property is a condominium, please check here________, and complete the back of this form.
Relationship between borrowers: Husband and wife______Other _____Please describe

Email: ____________________________________