Escrow Certification - SR ROA Statement of Account

Please complete the information below, including checking the appropriate boxes to acknowledge that the ROA documentation listed (which you may need for the sale or refinance of this property) is available for download under the Realtor Resources tab.

Today's Date:
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Closing Date (if applicable):
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Property Address: *
City: *
State: *
Zip Code: *
Requestor Company: *
Requestor Name: *
Requestor Phone Number: *
Requestor E-mail: *
Current Owner: *
Buyer / New Owner: *
Buyer / New Owner Phone Number: *
Buyer / New Owner Email Address: *

Schedule of Fees:  Escrow Processing = $125 (applies to all home sales); New Account Set-up = $50 (applies to all home sales);
Refinance/Corporate Relocation Statement = $50 (if selected); Expedited Service = $75 (optional upon request)

I acknowledge that the following documents are available on the ROA website under the "Realtor Resources" tab. If required, I have provided these documents to the Buyer of the property listed above:
My Digital Signature *
Expedite Request? (statement will be processed by the next business day; a $75 service fee applies)
Is this request for Refinancing or Corporate Relocation purposes?