Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Secure 1031 Exchange Services, LLC Intake Form To begin your 1031 exchange, please fill out or mark each line item in this form. Please note that some line items require you to attach and e-mail documents in a follow-up e-mail to secure1031@esecuritytitle.com. If you have any issues or questions, we're happy to help and the contact information of our experts is at the bottom of this form. 1. Name and Agency # of Security Title Agent2. Name and contact information of person who will be the point of contact at the referring agency for this transaction:3. Has the 1031 Exchange Cooperation language been added to the Purchase Agreement signed by the Exchanger and/or seller?YesNoWho holds title to the property to be exchanged? 1. Individual2. Corporation3. LLC (Single or Multiple Member)4. Trust5. Other6. EIN or SS: *Please contact either Sean (601-966-3593) or Brent (573-424-4298) to provide this information 7. Physical Address of Exchanger8. Phone Number of Exchanger9. Additional Documents to be E-mailed to 1031exchange@esecuritytitle.com:Operating AgreementPartnership AgreementTrust DocumentsCorporate Signing Resolution* Please select the box of each attached document in your follow-up e-mail Exchanger been be Name and contact information for all signers (POA, Attorney, RE professional, etc.) Please note the capacity of each contact NameContact info (Phone # or E-mail)CapacityNameContact info (Phone # or E-mail)CapacityNameContact info (Phone # or E-mail)CapacityNameContact info (Phone # or E-mail)CapacityNameContact info (Phone # or E-mail)Capacity Add Remove Relinquished Property Information 1. Full Address2. Closing Date3. Copy of Sales Contract (Is this attached in your follow-up e-mail?)YesNo4. Title Commitment (Is this attached in your follow-up e-mail?)YesNo5. Estimated Funds to Qualified Intermediary6. Debt Against Property7. Relinquished Property Closing Agent Contact Information8. Is the exchanger under contract to purchase replacement property? (If yes, please attach a copy of the Purchase Agreement in your follow-up e-mail)YesNoPlease describe any peculiarities regarding this exchange (i.e. Seller Financing, etc.)Once this form is completed, click the "Submit" button below and please email any attachments to secure1031@esecuritytitle.com. This will allow us to open the file and begin the 1031 Exchange process on our end. Please expect to receive a call or email from Beau Cassidy who will be your point of contact throughout the 1031 Exchange Process. For any additional questions, please contact: Sean M. Culhane, Esq. (601) 966 - 3593 | sculhane@esecuritytitle.com Brent Scheer, CPA (573) 424 - 4298 | bscheer@esecuritytitle.com Thank you for choosing us as the partner for your 1031 exchange and we look forward to guiding you through a seamless transaction. Submit