STATUS CERTIFICATE REQUEST

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Date of Request:*

Corporation #:*

Unit/Suite #:*

Address:*

Address Line 1

Address Line 2

City

Province

Postal Code

Owner's Name:*

First Name

Last Name

Your Name:*

First Name

Last Name

Your Email:*

Telephone #:*

Reason for Request*

Sale Refinancing

Other:

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Name of Purchaser 1:*

First Name

Last Name

Name of Purchaser 2:

First Name

Last Name

Name of Purchaser 3:

First Name

Last Name

Purchaser Telephone #:*

Purchaser Email:*

Closing Date:*

Name of Lawyer/Firm:*

Lawyer's Telephone #:*

Lawyer's Email:*

______________________________________________________________________________________

Status Certificate preparation

Type of Service / Prepared within / Cost + Convenience Fee = Total Payable

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Select Service Type:*

Regular Delivery within 10 Days / $100.00 + $5.26 (conf fee) = $105.26 Rush Delivery within 5 Business Days / $100.00 + $31.58 (conf fee) = $131.58 Priority Delivery within 1-2 Business Days / $100.00 + $57.89 (conf fee) = $157.89

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Credit Card Type:*

VISA MasterCard

Card #:*

Expiration Date:*

Card Verification Code (CVC):*

I authorize Central Erin Property Management to charge my card in the amount of $105.00 for preparation of the Status Certificate.

I authorize Central Erin Property Management to charge my card in the amount of $131.25 for preparation of the Status Certificate.

I authorize Central Erin Property Management to charge my card in the amount of $157.50 for preparation of the Status Certificate.

Name on the Card:*

First Name

Last Name

Date*

Signature of Cardholder*

[clear]

Use your mouse or finger to draw your signature above

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FOR OFFICE USE

Received ____________ Payment processed _____________ Trans # ______________________________

Completed by___________ Emailed by__________ Filed in the unit file _____________ Date____________