Settlement Request Form

* indicates a required field.

Name of Company Making Request *

Contact Person *

Phone Number *

Email *

Address of Property Served by HTMA *

Date of Settlement *

Seller(s) Name *

Seller's Agent's Email *

Buyer's Name(s) *

include all persons who will be listed on the deed

Buyer's Contact Information *

email and/or phone

Buyer's Agent *

Buyer's Agent's Email *

Is Buyer going to reside at property address?

Yes

Buyer's Mailing Address

Additional Notes or Comments: