Date (mm/dd/yy)

Sale or Refinance SaleRefinance

Sale Price

Loan Amount

Contact Phone“(REQUIRED)”

Ordered By “(REQUIRED)”

Email “(REQUIRED)”

PLEASE PROVIDE THE FOLLOWING SELLER(S) INFORMATION

Name(s) “(REQUIRED)”

Marital Status “(REQUIRED)” MarriedSingleDivorcedWidowed

Home Phone Cell Phone

Email Address

PLEASE PROVIDE THE FOLLOWING BUYER(S)/BORROWERS INFORMATION

Name(s) “(REQUIRED)”

Marital Status MarriedSingleDivorcedWidowed

Home Phone Cell Phone

Email Address

PLEASE PROVIDE THE PROPERTY ADDRESS

Address Line 1 “(REQUIRED)”

Address Line 2

City “(REQUIRED)” State “(REQUIRED)” Zip Code “(REQUIRED)”

County “(REQUIRED)”

PLEASE PROVIDE THE FOLLOWING LENDER INFORMATION

Lender

Contact

Phone

Fax

Email Address

PLEASE PROVIDE THE FOLLOWING REALTOR INFORMATION

Agency Representing Buyer

Agents Name

Phone

Fax Number

Email Address

Agency Representing Seller

Agents Name

Phone

Fax

Email Address

Commission Percentage

 Split Flat Fee

Amount $

Special Arrangements

WHICH TYPE OF DEED IN NEEDED?
Warranty DeedQuit Claim DeedJoint and Survivorship Deed

WHICH OF THE FOLLOWING ARE NEEDED?
 EPA Survey Exception Deletion Comp Payoff Closing Protection Letter ARM Special Tax Search Home Owners Insurance Wiring Instructions Other

CHOOSE THE TYPE OF SEARCH NEEDED?
Present Owner SearchJudicial Lien SearchFull SearchTax and Legal

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