Mortgage Verification

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Please complete the following in full including all account numbers, phone numbers with area code, and
contact names and phone numbers. This form may be faxed back to the closers name listed below at (515)
645-5330.
Bankers Trust Company
th
620 S. 60
Street
West Des Moines, IA 50266
Mortgage Verification For:
_____________________________________________________________________________________________
Borrower(s) - property owners
_____________________________________________________________________________________________
Property Address
Mortgage Lender #1
________________________________________________________________________
________________________________________________________________________
Loan Number
Phone Number
________________________________________________________________________
Lender Address - city, state, zip code
Please include all Home Equity Loans and Lines of Credit - even with $0 balances
Mortgage Lender #2
________________________________________________________________________
________________________________________________________________________
Loan Number
Phone Number
________________________________________________________________________
Lender Address - city, state, zip code
Mortgage Lender #3
________________________________________________________________________
________________________________________________________________________
Loan Number
Phone Number
________________________________________________________________________
Lender Address - city, state, zip code
By their signature, the undersigned authorizes the lender to release the above information, including specifically any
payoff figures and abstract of title, to BANKERS TRUST COMPANY and/or assigns. Further, borrower
authorizes said lending institution to close and release all lines of credit which are a lien against the property referred
above upon receipt of payment in full or written authorization to close such account.
___________________________________________
___________________________________________
Seller
Seller
SS # ______________________________________
SS # ______________________________________
Forwarding Address:
_____________________________________________________________________________________________
Borrower’s Name _______________________________________________________________________________
Loan Officer
_______________________________________________ Phone Number: __________________
Processor
_______________________________________________ Phone Number: __________________
Closer
_______________________________________________ Phone Number: __________________

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