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Estoppel Questionaire

Estoppel Questionaire Form. Download PDF.

Date:
Homeowners/Condo Association name:
Property Address:

**Please Include a Ledger or Complete Breakdown of Fees**

THIS IS A REQUEST FOR FEES DUE IN CONNECTION WITH THE ABOVE THROUGH 30 DAYS FROM DATE OF COMPLETION OF THIS FORM. PLEASE COMPLETE IN ACCORDANCE WITH FLORIDA STATUTES.

IF BANK OWNED PROPERTY PAYMENTS TO THE ASSOCIATION CANNOT BE PROCESSED WITHOUT A COMPLETED W-9 FORM. UNLESS PREVIOUSLY SUBMITTED PLEASE COMPLETE AND SEND. FOR OUR ONLINE FORM TO BE IS ADMISSIBLE; IT MUST BE COMPLETED INCLUDING TAX ID INFORMATION, BUSINESS NAME, ADDRESS, COMPLETION DATE AND NAME OF PARTY COMPLETING FORM. Download IRS W9 FORM.

Association Name:
Association Contact & Phone:
Association tax id number (required for payment):
Management Company:
Management Contact & Phone:

Mail payments to Association

Mgmt Co.

Atty.

Other

Mailing Address for payment:
Make checks payable to:

Maintenance Fees: $

Payable:

Monthly

Quaterly

Annually

Other

Fees Include:

Water

Sewer

Garbage

Master Meter

Sub Meter

Individual Meters

Are the fees current:

Yes

No

Past due amount:

Last payment made:

Next payment due:

Late fees due:

Yes

No

Late fee $

due if payment received after

Please verify the amount of any credit balance to this account:

Do the fees indicated include fees for more than one association

Yes

No

If yes, please provide association name:

Do homeowners pay fees to addl association(s) please provide contact:

Yes

No

Second Association Name:		Ph:
Third Association Name:		Ph:

Contact an attorney for fees or any payoff? Please provide contact:

Yes

No

Firm Name:

Contact Name:

Phone:

Is there a recreational lease

Yes

No

If yes fees

paid thru:

Recreational lease contact/phone:

Are there any special assessments

Pending

Certified

If yes, how much was the original assessment amount:

Balance due:

Reason for special assessment:

Please provide copies of all notices to owner(s) including detailed break-downs and all payment due dates.
Please provide a copy of any Amendment(s)to the Declaration/By-Laws not recorded in the Public records.

Is association approval required for transfer

Yes

No

Fee:, if any: $

Approval contact person & phone number:

Is there a Right of First Refusal Clause:

Yes

No

Is the association party to any current or pending litigation:

Yes

No

If yes, please explain

Please provide any parking designation or assigned parking info:

Insurance Agent (Master Policy):		Ph:
Insurance Agent (Flood):		Ph:

Fidelity bond coverage in place:

Yes

No

Agent Contact:

Is association in good standing with State of Florida Division of Corporations?

Yes

No

List violations or required corrections:

PLEASE PROVIDE ANY ADDITIONAL RELEVANT INFORMATION:

Information provided is good through thirty business days unless otherwise noted herein:

FAILURE TO PROVIDE A SATISFACTORY LEDGER OR BREAKDOWN AND EXECUTED W-9 COULD RESULT IN A DELAY IN TIMELY PAYMENT OF ASSESSMENTS. Download IRS W9 FORM.

Completed by:

Association

Management Co.

Other

Name: Electronic Signature

Date Completed:

Phone Number:

Email Adress:

Notes:  
Please provide email information where requested so a copy of this form will be sent to you via email for your records.
The party completing and submitting this form hereby confirms that they are authorized to do so on behalf of the association named herein.